In-Territory Travel Claim Form April 1 – March 31

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In partnership with IN‐TERRITORY TRAVEL CLAIM FORM APRIL 1 – MARCH 31 (To be filled out by Individual) NOTE TO SPORT GOVERNING BODIES: In‐Territory claim forms are due by the end of each month immediately after the event in which travel took place. (Example: Travelled 5 times in November; claim form due by Dec 31) PAYMENT/EVENT: The travel rate is set at $.10/km per person for all authorized; Arctic Winter Games Trials, Yukon Representative Team Travel, and Coach Training Opportunities. The travel rate is set at $.05/km per person for Yukon Championships. REFERENCE GUIDE / STANDARD TRAVEL DISTANCE CHART (KM ‐ ROUND TRIP) Whitehorse To Dawson To SUBMIT CLAIM TO / CONTACT Beaver Creek 914 Haines Junction 315 Faro 1077 Please submit your completed form to your Burwash Landing 570 Keno City 934 Watson Lake To Sport Governing Body for authorization. Carcross 148 Mayo 814 Faro 874 This form MUST be signed by the individual Carmacks 351 Pelly Crossing 563 Mayo To: being paid as well as an authorized Dawson City 1077 Ross River 808 Dawson City 450 representative from the SGB prior Destruction Bay 531 Teslin 367 to submitting it to SARB. Elsa 904 Watson Lake 911 Faro 702 CLAIM PERIOD / SPORT YEAR MONTH SPORT TRAVEL INFORMATION FROM DRIVER OF VEHICLE TO CHEQUE PAYABLE TO MAILING ADDRESS EVENT INFORMATION PURPOSE OF TRIP DATES ATHLETE TOTAL TOTAL CLAIM Note: If the purpose is a Championship and there is a large number of athletes; please attach a separate sheet with a list of the team members and put the total under “Athlete” ATTACHED Yes No AUTHORIZATION 1. CLAIMANT 2. SPORT GOVERNING BODY 3. YG SPORT & RECREATION DATE NAME SIGNATURE SPORT YUKON PAYMENT INFORMATION (Cheque # and Date Paid) .

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