SAGE Days 2006 Conference 

Travel Reimbursement Information 

Please print legibly 

NAME:_________________________________________________           

U.S. Citizen   Y    N                 VISA_____________

If you are not a US citizen, please provide a copy of your passport and visa.

B visa’s or Visa Waivers must fill out Academic Certification form for reimbursement. 

MAILING ADDRESS: 

________________________________________________ 

________________________________________________ 

________________________________________________ 

E-mail address:  ___________________________________

SOCIAL SECURITY NUMBER:      ________________________         (REQUIRED)

DESTINATION:___________UC San Diego___________________________________

PURPOSE OF TRIP:______SAGE Days 2006 Conference________________________

DATES OF TRIP:____________Feb 4-5, 2006_________________________________

If you drove to UC San Diego, please provide the year, model, and license plate number of your  

vehicle, and how many miles you drove round trip. 

__________________________________________________________________ 

Please provide ORIGINAL receipts for this trip in the attached envelope and  

mail  to:

Anita McKee 

Dept of Mathematics 

Univ of Calif, San Diego 

9500 Gilman Drive, 0112 

La Jolla, CA  92093-0112