Request for Out-of-State Travel

Name
Current Date
Event
Date(s) of Event
Location (city/state)
Your e-mail address

Preferred Travel Dates & Times
Departure (specify date & time/a.m. or p.m.)
Date:
Time:

With a return after (specify date & time/a.m. or p.m.)
Date:
Time:
I am seeking time off from work and/or funding to attend the event noted above. It is in the interest of Information Resources that I attend because:
Projected cost (accuracy is essential!)
Transportation	Cost
Airplane	$
Misc. Ground Travel (parking, mileage, taxi, shuttle)	$
Registration	$
indicate if meals are included w/fee
Lodging	$
Meals (applicable only if overnight stay included)	$
Grand Total	$
Please Choose One:
Request funding and time off
Request time off only
I have discussed this request with my Unit Manager: Yes No Please forward any descriptive literature and registration forms you may have regarding your trip to Peggy Dollard.