204, 200 Country Hills Landing NW
Calgary, Alberta T3K 5P3
Toll Free: 1-844-280-4722
Fax: (403) 250-8576
[email protected]
18410 – 100 Avenue
Edmonton, Alberta T5S 0K6
Toll Free: 1-844-280-4722
Fax: (780) 488-0534
[email protected]
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Members’ Expense Form
NAME: _____________________________________
EMPLOYER: _________________
HOME ADDRESS: _____________________________________________
SITE: C________________________
o
CITY: ____________________
u
PC: _____________
n _______________________
PURPOSE: ____________________________________________________________________ SIN:
t
MEMBERSHIP NO.: _________________________
IMPORTANT: Payment will not be made if receipts
are not attached for
r
y IF SIN IS INCORRECT.
air, taxi, parking, bus, or accommodation OR
TRANSPORTATION (attach receipts)
TYPE
DATE
FROM-TO
Air/Bus
OFFICE USE
l
l
s
Taxi/Limo
•
H
AMOUNT
i
Driver:
Mileage @ 55¢/km
Passenger @ 5¢/km
Passenger:
Car/bus @ 20¢/km
Parking
L
a
n
d
i
n
g
MEALS (Per Diem: Breakfast $12.00; Lunch $15.00; Supper $25.00)
DATE
INCIDENTALS
DATE
ACCOMMODATION
DATE
WAGES (MUST COMPLETE)
DATE
Member’s Signature:
PURPOSE
MEAL
AMOUNT
OFFICE USE
INCIDENTAL
AMOUNT
OFFICE USE
ACCOMMODATION
AMOUNT
OFFICE USE
RATE
OFFICE USE
HOURS
________________________________________________________________
In order to process, this form MUST be signed by member.
EXPENSE GUIDELINES
TRANSPORTATION:
MILEAGE:
Mileage will be reimbursed at a rate of 55 cents/km. When members car pool, an additional
5 cents/km will be paid for each passenger. AMA charts will be available for reference. A
passenger in either a car or a bus will be paid 20 cents/km.
AIR:
Members are encouraged to travel by air where schedules permit and where the total cost
of airfare, hotel and meals would be less than the total cost for car mileage, hotel and
meals. The Finance Committee reserves the right to reimburse members for the more
economical mode of transportation.
BUS, TAXI AND PARKING:
Full reimbursement with necessary receipts.
MEALS:
When meals are provided by the Association, the per diem for meals cannot be claimed. The meal per diem can be
claimed if travelling during meal time.
ACCOMMODATION:
Hotel room accommodation only, i.e., no room service or telephone charges will be allowed.
Members travelling more than 80 kilometers before 9:00 a.m. will be entitled to hotel accommodation the night preceding
the meeting. If a member travelling after a meeting is unlikely to arrive at her final destination before 9 pm, and she lives
more than 80 km from the meeting, she is entitled to hotel accommodation following the meeting.
All other requests for hotel accommodation will require prior approval.
WAGE REPLACEMENT: (at the rate provided by the collective agreement)
HSAA will provide wage replacement, including premiums, if approved meetings are attended on a scheduled work day.
OTHER EXPENSES:
May be reimbursed with approval of the Finance Committee.
In order to process this form, it MUST be signed by the member.
ALL EXPENSE FORMS ARE SUBJECT TO FINANCE COMMITTEE APPROVAL.
THE COMMITTEE RESERVES THE RIGHT TO MAKE ANY NECESSARY CORRECTIONS.
Additional Guidelines apply to board members and members serving on Committees.
GUIDELINES ARE SUBJECT TO CHANGE BY THE BOARD.
Members’ Expense Form 01122016