TRAVEL REIMBURSEMENT FORM (attach receipts for any expense of $25 or more)

Member’s Name: ______NAIFA Member #: ______

Address: ______

Phone: ______Email: ______

I am with (check if applicable): New York Life Northwestern Mutual Thrivent Mass Mutual *

Hotel Expense - Cost of one room night at a NAIFA Conference Hotel. (If two [or more] members share a room, both Members may not seek reimbursement for the full cost of the room). $ ______

Travel To/From the Conference

Check if:  air  rail  bus $ ______

OR

Automobile mileage: ______miles from ______(city/state) to the Conference @ .575 cents per mile $______

Local Travel(explain briefly):

______$ ______

TOTAL$ ______

Member’s Signature ______Date ______

Return Complete Form & Receipts to: Ian DelsolCheck here if you are a

2901 Telestar Court State President-Elect and

Falls Church, VA 22042 you attended the May 19

meeting at the Hilton

703-770-8151 Fax Crystal City Hotel

This Section for NAIFA Office Use Only:

Amount to be reimbursed (79050-10-200-1005)– Not to Exceed $350$ ______

SPE Meeting amount to be reimbursed (79000-10-150-3000)$ ______

Total$ ______

Approval ______Date ______

* This question is being asked for reimbursement policy purposes only; it is not being asked in order to identify your primary company.

TRAVEL REIMBURSEMENT GUIDELINES

NAIFA will reimburse the first 600 NAIFA members who register to attend the NAIFA Congressional Conference (May 19th-20th, 2015) for reasonable and necessary travel expenses up to $350 per member. NAIFA members who register after the first 600 will be placed on a waiting list, and registrants will be rolled into the first 600 eligible for reimbursements in the order they were received as cancellations occur.

GENERAL GUIDELINES

To be eligible for expense reimbursement, you must:

1. Be an active NAIFA member as of May 19th, 2015;

2. Actually attend the Congressional Conference;

3. NAIFA must receive your $100 registration fee by April 20th, 2015;

4. Stay at the official Conference hotel(s) (unless your residence or principal place of business is in the immediate Washington, DC area);

5. Submit a debriefing form, which summarizes each meeting with a member of Congress; and

6. Submit an expense reimbursement form, together with receipts for expenses actually incurred.

The debriefing and reimbursement forms will be provided at the Conference and will be online afterward, so please save your applicable receipts.

REIMBURSABLE EXPENSES

Travel

• Reasonable and necessary (i.e., not “first class”)fare for travel by air, rail, or bus, including the cost of one checked bag.

OR

• Actual miles driven between home or place of business and Washington, DC at the IRS-approved mileage rate.

• Parking & Tolls (for those driving to Washington)

• Taxi/bus/shuttle/Metro fares between airport and hotel

Hotel

NAIFA will reimburse one night’s hotel room and tax at the Hilton Crystal City at Washington Reagan National Airport or another officially designated Conference hotel, should there become a need to designate one. Incidentals are not eligible for reimbursement. If the attendee chooses to stay at another hotel or with a family member or friend, he/she will not be compensated for the cost of the used or unused hotel room.

Registration Fee

The $100 Congressional Conference registration fee can be claimed as a reimbursable expense.

CANCELLATIONS/CHANGES TO ITINERARY

If a trip is cancelled by the attendee after the air, rail or bus ticket has been issued, he or she will be responsible for the cost of the ticket. NAIFA will not reimburse for the cost of canceled tickets, unused tickets or cancellation/change fees.

If the hotel reservation is canceled by the attendee and the hotel assesses a charge, the attendee will be responsible for the charge.