2016 Great EsCCAPe n Flight Reimbursement Form

Instructions: Please complete this form and submit it by:

·  email it as an attachment, along with your receipt from your flight, to

·  mail the information to Cultural Care Au Pair, ATTN: Events Department, 8 Education St., Cambridge, MA 02141.

In order for your flight to be reimbursed, you must:

1.  All budgets listed above are per person for roundtrip flights from your home gateway to your destination and include all airline fees and taxes associated with the fare only

2.  Fully complete the information on this form and submit it.

3.  Submit your complete flight receipt including your itinerary.

4.  Failure to do any of these steps or submission of incomplete information will delay your reimbursement.

Flight budget*: I have attached receipts for my transportation to and from the great esCCAPe in adherence to the following budgets:

Gateway region / Miami / Greece
East Coast / $ 425.00 / $ 1,000.00
Midwest / $ 425.00 / $ 1,100.00
West Coast / $ 500.00 / $ 1,225.00

□  Las Vegas

□  London

□  East Coast

□  Midwest

□  West Coast

*Terms and conditions: All budgets are for round-trip flights from your home gateway your destination and include all fees and taxes. Transportation to and from your home and/or parking at your gateway are not eligible for reimbursement. Any baggage, booking, upgrade, insurance or seat fees imposed by the airlines will not be reimbursed by Cultural Care. If you use Frequent Flier miles or previous airline credits to pay for your flight, you will not be reimbursed for your flight.

_____ Yes, I have attached my complete flight receipt.

Check Request

______

LCC full name: ______

Mailing address: ______

______

Total amount to be reimbursed: $ ______

LCC signature ______Date ______# of Points______

(If you have direct deposit set up, your reimbursement will be deposited in your account. Otherwise, you will receive a reimbursement check by mail. Please allow 30 days for your request to be processed.)

For office use only:

Approved by ______Date ______

Acct CC: 7251.MUS.APW.CMK100.SSUMMIT