<p> EXPENSE FORM NORTH CAROLINA WOMEN OF THE ELCA</p><p>Name______Date ______Address ______City ______Telephone ______Zip ______Event/Activity ______Expenses incurred for ______Person(s) traveling with you ______Committee(s) they serve on ______Food/Lodging______Honorarium ______Postage ______Phone ______Travel ______miles @ $.25= ______Travel (donated)______miles @ $.14 = ______Miscellaneous (specify) ______Total expenses incurred $______</p><p>Please designate the line item: _____ Administration (Board) _____ Discipleship _____ Justice _____ Stewardship _____ Conference Leader _____ Other ______Gathering Program Planning</p><p>Mail to: Nena Babb 6130 Heavner Road, Vale, NC 28168 _____ In lieu of reimbursement, please send me a receipt so that I can claim this amount as a contribution to Women of the ELCA. </p><p>------(For Treasurer’s use only)</p><p>Date Paid ______Check Number ______Comments ______Treasurer ______Revised 2/28/2017</p>