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Submit form to: Local alliance Treasurer
Questions? Contact TAME State Office (512) 471-6100   Fax: (512) 471-6797
 
     Date Submitted: ___________________
Name (Volunteer): _________________________________
Job Title: ________________________________________
Company Affiliation: _______________________________
Event/Activity/Meeting: ____________________________         Date of Event: ____________________
 Estimated or actual value of in-kind contribution:
 
TIME/CONTRIBUTED PROFESSIONAL SERVICES
Person
x
Amount
Vendor (if applicable)
x
$25
=
x
x
$25
=
x
x
$25
=
EQUIPMENT/SUPPLIES
Items Contributed
Amount
Vendor (if applicable)
$
$
TRANSPORTATION
Person
x
# Miles
$0.445
=
$
x

$0.445

= $
x
$0.445
=
$
FOOD/CATERING
Item
Amount Vendor (if applicable)
$
$
PRINTING AND PUBLICATION EXPENSES
Item
Amount Vendor (if applicable)
$
$
OTHER
Item
Amount
Vendor (if applicable)
$
$
$
TOTAL ($)

$

 
TOTAL HOURS: