Travel Authorization Form ACB Travel Authorization Travel DetailsDate* MM slash DD slash YYYY Traveler's Name* First Last Email* Traveler's UFID (no dash)* Position Title Name of Conference Purpose of Trip Annual Meeting Presentation Moderator Justification (Explain Benefit to State) Funding Source Grant Project PI Overhead Dept Overhead Grant 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 Name Registration Prepayment Needed: Yes No Registration Prepayment Due Date Mode of Transportation Air Rail State car Personal car Rental car Date of Departure* MM slash DD slash YYYY Departure Time : Hours MM AM PM AM/PM Date of Return* MM slash DD slash YYYY Return Time : Hours MM AM PM AM/PM Number of DaysAirport Departing From Airport 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 Method Pcard Personal CC Hotel Price per dayHotel DaysHotel Total Price: $0.00 Method of Payment Pcard Personal CC Meals 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 Payment Pcard Personal CC Rental 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 Payment Pcard Personal CC Personal 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 By Traveler'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 100235CommentsThis field is for validation purposes and should be left unchanged.