Parent Education Presenters Invoice
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Parent Education Presenters Invoice Form. This is a West Virginia form and can be use in Parent Education Supreme Court Of Appeals.
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Tags: Parent Education Presenters Invoice, SCA-FC-604, West Virginia Supreme Court Of Appeals, Parent Education
Parent Education
PRESENTER’S Invoice
Submit completed form to:
Pepper Flenner
WV Supreme Court of Appeals
1900 Kanawha Blvd.
Building 1, Room E-100
Charleston, WV 25305
Presenter: ______________________________________________
Make check payable to: __________________________________
Address for remittance: _____________________________ Social Security or FEIN___________________
_____________________________
Phone (home): ______________________________ Phone (work):____________________________
Fax:__________________________ E-mail address:__________________________________________
Class information: (ONE class per invoice)
Date ___________ County ___________________________ Number: paid _____ waived _____
* Please check appropriate box below:
Bachelor’s Degree ($100.00 per session)
Masters’ Degree ($115.00 per session)
Doctoral Degree ($130.00 per session)
Total Session Fees
$______________
* Out-of-County Mileage (available only if traveling to present class outside of home county)
Home county: ___________________________
Round trip miles traveled _______ x $0.____ =
Total mileage
$______________
* Out-of-Pocket Fees (a receipt must be attached to receive reimbursement)
Amount due _________
Description _______________________________________
Out-of-pocket fees
$ _____________
Add session fees, mileage, and out-of -pocket fees:
Total Due
$______________
Presenter’s signature: (Must be in blue) ____________________________________________ Date:____________
Administrative office use only:
Approved: _____________________________________________________ Date: ________
SCA-FC-PE-604 (12/07)
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