|
Please use the Tab
button to move
within fields, pressing
enter will submit your form prematurely. |
|
*
required fields |
| *
Name |
|
| *
Address |
|
| *
City |
|
| *
State |
|
| *
Zip |
|
| *
Email |
|
| *
Phone |
|
| *
Event |
|
|
|
|
Please enter your mileage below |
| Beginning
Location |
|
| Destination |
|
| Roundtrip
Mileage |
X .30¢ |
If you had any staff as
passengers,
please list their names
($12.50 - One Way, $25.00 - Roundtrip): |
|
(minimum of 50 miles one way, unless daily commute is excessive)
|
| Total Amount for Mileage/Passengers:
|
| |
|
Rental Car Information |
| Rental Car Company |
|
|
If you had a rental car,
please list amount for reimbursement |
|
|
Gas Fill Up Amount |
|
Total Amount for Rental Car:
|
| |
|
If
you had any custom routines, please enter the number of routines
you
choreographed by the type
of routine
in the
appropriate box below |
Jr
Custom Routine
(Field or Pop music, Time limit is under 2:15) |
#
x $50 |
Elementary Custom Contest
Routine
(Pop music, Time limit is over 2:15) |
#
x $75 |
Jr
Custom Contest Routine
(Pop music, Time limit is over 2:15) |
#
x $100 |
High
School Field / Pep Rally
(Field or Pop music, Time limit is under 2:15) |
#
x $100 |
High School Contest Custom
(Pop music, Time limit is over 2:15) |
#
x $150 |
Have you already sent
your notes to the office? |
Yes or
No |
|
Click Heree to
email your routine notes to the office if you have not
done so already. Please note that
payment for customs will not be issued until you typed
notes are
received in the office. |
| Total Amount for Customs:
|
| |
|
*
GRAND Total
amount due: $
|
