Club Reimbursement Form

Date of Reimbursement:

Officer Issuing Reimbursement:

Position of Officer: [ ] President [ ] Treasurer [ ] Advisor

Name of Reimbursement Recipient:

Amount of Reimbursement (US Dollars):

Description of Expense:

You must attach a receipt if the recipient is not selling or rendering services directly to the club. If SAFC funds will be used towards this purchase additional requirements may apply. If any questions arise about procedure, please consult with the treasurer and, if necessary, SAFC staff to assure compliance with pertinent policies.

This form certifies that the above recipient was reimbursed by the above officer on the specified date for expenses authorized in advance by and for the Cornell Outing Club. This form is only valid if signed by the recipient and officer issuing reimbursement.

Signature of Recipient:

Signature of Officer:

-- AriEpstein - 20 Jul 2005