Travel Authorization Form ACB Travel Authorization Travel DetailsDate* Traveler's Name* First Last Email* Traveler's UFID (no dash)*Position TitleName of ConferencePurpose of TripAnnual MeetingPresentationModeratorJustification (Explain Benefit to State)Funding SourceGrant ProjectPI OverheadDept OverheadGrant Project #Outside Employment Yes No If Yes, be sure to disclose this through the eCOI system: https://bridge.ufhealth.org/college-of-medicine-compliance/conflict-of-interest/. If you haven’t submitted one through the system before, the Compliance Office for COM will be able to get a user name set up and they can be reached at 627-9001 or 627-5042.Organization NameRegistration Prepayment Needed: Yes No Registration Prepayment Due DateMode of Transportation Air Rail State car Personal car Rental car Date of Departure* Departure Time : HH MM AM PM Date of Return* Return Time : HH MM AM PM Number of DaysAirport Departing FromAirport Destination*Estimated Cost:Any unusual extra expenses due to changes in reservations may have to be borne by the traveler. Always coordinate reservations and/or changes with the department fiscal team.Air Fare Payment MethodPcardPersonal CCHotel Price per dayHotel DaysHotel Total Price: $0.00 Method of PaymentPcardPersonal CCMeals cost per dayMeals: Standard per diem = Breakfast $6.00, Lunch $11.00, Dinner $19.00 = $36.00 GSA per diem based on travel destination. See gsa.gov website for rates (Select policy/per diem rates)Meal DaysMeals Total Price: $0.00 Registration Method of PaymentPcardPersonal CCRental Car For rental cars please ensure you are only renting from Enterprise Rent-A-Car or National Car Rental https://legacy.enterprise.com/car_rental/deeplinkmap.do?bid=028&refId=UNIFL or call 1-877-690-0064 and use reference Account number 43A3255.Method of PaymentPcardPersonal CCPersonal Car MilesPersonal Car Mileage Reimbursement Price: $0.00 (number of miles) X .58 *Rate according to 2019 Florida StatuesOther miscellaneous expenses Total $0.00 ApprovalsDuties Covered ByTraveler's Signature*Approved by:(Direct Supervisor)Reimbursement: To insure prompt processing of travel reimbursement, all pertinent data and receipts must be forwarded to the Fiscal Section within five (5) working days of employee’s return. Please be advised that it is to your advantage to retain ANY and ALL receipts that reflect funds expended while on your trip. FISCAL OFFICE: Room B1-012A, 1st Floor, Basic Science Building; (352) 273-8472; PO Box 100235NameThis field is for validation purposes and should be left unchanged.