D.O.R. Representative Assignment Report

Complete one of the two following forms for a representative flying in or driving in for the event.

*Please note a copy of the form will be emailed to the representative selected

For Representative who will be flying in for the event-

Name of Event:*
Event License Number:*
Event Date:*
 / 
 / 
Representative selected for event:*
Was this the hosts first choice in representatives?*
If no, explain why each of the hosts choices were not selected:
Representative Phone:*
-
Representative E-mail:*
Representative Fee: (maximum amount allowed is $125 per show):*
What are the 2 closest airports to the Representatives home?
Airport 1:*
Approximate Distance to Airport 1:*
Airport 2:*
Distance to Airport 2:*
will the representative be REQUIRING parking reimbursement? (maximum $12.00 a day)*
Soonest available departure date:*
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 / 
Soonest avilable departure time:*
 : 
Latest aviable return date:*
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Latest available return time:*
 : 
Directors Electronic Signature:*
Director E-mail:*

 

For Representative who will be Driving in for the event-

Name of Event:*
Event License Number:*
Event Date:*
 / 
 / 
Representative selected for event:*
Was this the hosts first choice in representatives?*
If no, explain why each of the hosts choices were not selected:
Representative Phone:*
-
Representative E-mail:*
Representative Fee: (maximum amount allowed is $125 per show):*
What is the exactly travel mileage from Representatives home to the event site?:*
Mileage Reimbursement amount per mile (maximum amount allowed is $.40 per mile)*
will the representative be REQUIRING parking reimbursement? (maximum $12.00 a day)*
If driving less than 4 hours away a representative should be accommodated for up to a maximum of 1 night, If driving more than 4 hours  a representative should be accommodated for up to a maximum two nights.
Is the representative traveling for:*
Will the represenative need more or less than the MXIMUM allowed accomodations?*
If yes, please explain.
Planned arrival date:*
 / 
 / 
Planned arrival time:*
 : 
Planned return date:*
 / 
 / 
Latest available return time:*
 : 
Directors Electronic signature:*
Directors E-mail:*