Date Name Email Division - Select - EBC HASS Science Purpose of Travel - Select -to present a paperto serve as a moderator or discussantto serve as a committee chair or memberother Please specify Please give the following information about the paper: Please give the following information about the paper: Title Authors Name of Conference Location Travel Beginning Travel Ending Has your proposal for a paper been accepted? - None - Yes No (If 'NO,' please send confirmation of acceptance to your Division Head before traveling.) Proposed Budget Proposed Budget Registration $ Shuttle $ Airfare $ Mileage Mileage: # miles x reimbursement rate = Subtotal for Mileage $ Lodging Lodging: # nights x cost per night = Subtotal for Lodging $ Meals Meals: # days x meal cost per day = Subtotal for Meals $ Miscellaneous (please explain) Subtotal for Miscellaneous $ DEADLINE Deadline: Due JUNE 1 for July 1 of this year to June 30 of next year. Total Budget $ Other Funding Sources Please include amounts Travel Reimbursements $ Submit all receipts to: Gail Chiriani, EBC Division Danielle Moser, HASS Division Robin Raifsnider, Science Division Submit