PAGE Day on the Hill Please use this form to submit expense reimbursement requests related to your participation with PAGE Day on the Hill. Name* First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Enter Email Confirm Email Number of Miles Traveled (driver only) MileageMileage is automatically calculated at the national average rate of .535 per mile. Hotel (Enter total amount of hotel cost excluding incidents)Must provide copy of receipt to receive reimbursement. Please upload receipts below. Dinner Receipts (Enter total amount of all qualifying dinner receipts)Reimbursements will reflect uploaded receipts (maximum $25 per dinner which includes tax and 15% gratuity). PAGE does not pay for alcoholic beverages. Upload images of receipts (pdf, png, gif or jpg files accepted) Drop files here or Select files Accepted file types: pdf, jpg, gif, png, Max. file size: 50 MB. COMMENTS: If you have a comment or question, enter it here.TOTAL REIMBURSEMENT
