Member Information
Surname    First Name    AUPE Number    Chapter 
Address   Town/City 
Postal Code    Home Phone   Work Phone 

---

Activity
Activity associated with claim 
Location of activity 
Departure Date   Time    Return Date    Time  

---

Expenses

Expense					Amount	Code
Air Travel					$	7251
Kilometerage		km @ $0.52			$	7252
Parking					$	7252a
Taxi					$	7252b
Bus					$	7252c
Accomodation	days @ $ day				$	7253
($30/day without receipt or attach receipt)
Meals	Breakfast	@ $12 = $
	Lunch	@ $14 = $
	Supper	@ $20 = $			$	7254
Misc Per Diem	days @ $10 = $				$	7255
Registration Fees (attach original receipt)					$	7257
Other (attach receipts and provide explanation)					$
			Total		$
			Less Advance		$
			Balance		$

---

I certify that this is a true detailed account of expenses incurred on Union business.

Signature

Date