Clan Henderson Society of the United States of America
Expense Reimbursement Form - WEB EDITION

Henderson, Henryson, Henrisoun, Henders, MacHendry, McHendry, MacHenry, McHenry, Hendry, Henry, Hendrie, Hendron, d'Handresson, MacKendrick, McKendrick, MacKendry, McKendry, McKendree, Kendrick, and other versions of MacEanruig, "son of Henry."

DATE ________________   REGION _____________________________________

I request reimbursement of $________________________ for the items listed and totaled below.

Please mail check to:

Name __________________________________________________

Address ___________________________________________________

City _________________________________ State ________ Zip ____________

Telephone (with Area Code) ___(______)____________________________

List of expense items to be reimbursed:

List name, location, and dates of events to which these items relate.

Description Event Amount
  $ 
  $ 
  $ 
  $ 
  $ 
  $ 
  $ 
Total Amount$ 

Please attach supporting bills, invoices, contract copies that apply and be sure to keep a copy for yourself. Include an Activity Report if not already submittted.

Send to:

Ed Hendricks
VP - Clan Henderson Society of the USA
P.O. Box 669
Demorest, GA 30535

(706) 778-9636
ehendric@alltel.net