Southern District Pastors’ Conference

The Lutheran Church–Missouri Synod

2010 Pastors’ Conference

Reimbursement Request Form

Updated: 04.08.10

Please print!

Name: _____________________________ Congregation: ____________________________

Mailing Address: _____________________________________________________________

City/State/ZIP: ______________________________________________________________

Best Phone: ________________________   Email: __________________________________

Meals Reimbursement is handled through a meal allowance of $40 paid at the time of registration to those whose congregational assessment and professional fees are fully paid. Additional meal costs must be borne by the participant or his congregation/ ministry. The Wednesday evening banquet is provided by the conference, an $11 cost per person.

Hotel Reimbursement is available at a rate of $48.50 for each night you stayed in the Holiday Inn Trustmark Park – Pearl, MS. The reimbursement rate is one-half of our negotiated cost per room including taxes, for timely reservations, calculated on the expectation of double occupancy.

Please indicate which nights you stayed at the Holiday Inn Trustmark Park:

                        _____  Monday, April 12^th (circuit counselors’ meeting before conference)

                        _____  Tuesday, April 13^th

                        _____  Wednesday, April 14^th

Mileage Reimbursement is available at a rate of $0.38 per mile for those traveling in excess of 150 miles. This is for the shortest reasonable distance between your home and the Holiday Inn Trustmark Park. It doesn’t include local mileage. Mileage under 150 miles should be charged to your home congregation. If you don’t know the distance, we will use a mapquest type program to calculate the mileage. Car pooling is encouraged as good stewardship but carries no reimbursement incentive in 2010. This reimbursement is payable to the driver/owner incurring the expense, not to passengers. This policy is subject to change based on finances.

            Distance one-way from your home to Pearl, MS:                       __________

            Less 150 miles                                                                                   – 150

            Net pastors’ conference reimbursable one-way distance:         __________

                                                            Times 2 for two-way mileage:      __________

By my signature I certify that this is a true and accurate statement of reimbursable expenses.

Signature: _______________________________   Date: _____________________________

This form must be submitted to conference treasurer Stewart Marshall by April 30, 2010. Please turn in at the conference or mail to Prince of Peace Lutheran Church, 2454 Andrews Ave, Ozark, AL 36360. Reimbursement checks will be mailed to participants in a timely way.

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For Office Use:         Date Received:         ________________

                                    Congregation Assessment & Professional Fees Paid? Y/N: _______

                                    # room nights:                      ________ x $ 48.50 = ______________

                                    Reimbursable miles:            ________ x $ 0.38 =  ______________

                                    Total Reimbursement:                                            ______________

                                    Check #:                    ________________

                                    Date Mailed:             ________________