EMA Reimbursement Request Form

Please return this form to EMA Headquarters for reimbursement of approved expenses. Receipts are required for all items except automobile mileage.

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Name
First Last
Email
Date(s) of event*
Month
Day
Year
Purpose of Reimbursement*
CHECK PAYABLE TO:*
Address to send check:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
EMA Training Instructor Fee ($)*
- EMP Virtual - $1000
- EMP In-Person - $1500
- O&M Training - $1000
- Property Manager and Building Owner Training - $1000
- Other EMA Training
If other, please list the EMA training and fee:
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EMP Seminar, O&M Training, or other EMA Training Instructor Fee ($)
EMP Virtual - $1000 : EMP In-Person - $1500 : O&M Training - $1000 : Other EMA Training - $1000
Airfare (coach class only, 60-day advance ticket purchase required) ($)
Hotel Accommodations ($)
(One night only, under the contracted group rate. Special approval from ACG is required for the second night)
Taxi Cab Fares ($)
Parking Fees ($)
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Automobile Mileage (multiply your total number of miles times $.67 per mile and enter the result here)
Automobile Mileage (multiply your total number of miles times $.67 per mile and enter the result here)
Other ($)
TOTAL REIMBURSEMENT DUE ($)*
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Please allow up to 30 days for processing. Should you have any questions, contact EMA Headquarters: accounting@energymgmt.org or call 202-737-1334.

EMA Reimbursement Request Form

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EMA Reimbursement Request Form

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