2025 MPA Host Expense Form

2025 MPA Host Expense Report Form

Thank you for hosting! Please complete the form below and include all receipts for which you are requesting reimbursement. Form should be submitted within one week of the event.

Date of MPA *
N/A

MM-dd-yyyy
MPA Site *
N/A
Host Name
N/A

Required First Required Last
Host Email Address: *
N/A
Host Honorarium
Regarding Host's participation in the event: *
N/A

We would like a check for the host honoraria amount of $175
We have applied the $175 host honoraria to our total Registration Fees owed and will mail a check to the PMEA Office for the remaining balance, if any
We have applied the $175 host honoraria to our total Registration Fees owed and would like a check for the remaining amount
Please list the name to whom the honoraria check should be issued (i.e. district, school, activity account, etc.) and the mailing name (if different from to whom the check is written) and address:
N/A
Please list the name to whom the check for the remaining honoraria should be issued (i.e. district, school, activity account, etc.) and the mailing name (if different from to whom the check is written) and address:
N/A
Host Hospitality Expenses
Amount of Reimbursement Requested for Hospitality USD
N/A

(Up to $130 for Large Ensemble MPAs. Up to $175 for Solo & Small Ensemble MPAs.)
Attach Receipts And/Or Invoices for any expenses pre-approved by MPA Coordinator Tom Snyder
N/A
Upload file
If applicable; Receipts/invoices must be submitted to be authorized for reimbursement (and must have first been approved by the MPA State Coordinator)
Please list the name to whom this check should be issued (i.e. district, school, activity account, etc.) and the mailing name (if different from to whom the check is written) and address:
N/A
Other Expenses
Other expenses that have been pre-approved by MPA Coordinator Tom Snyder: USD
N/A

Please attach receipts or invoice below - if applicable.
Attach Receipts And/Or Invoices for any additional expenses pre-approved by MPA Coordinator Tom Snyder
N/A
Upload file
If applicable; Receipts/invoices must be submitted to be authorized for reimbursement (and must have first been approved by the MPA State Coordinator)
Please list the name to whom this check should be issued (i.e. district, school, activity account, etc.) and the mailing name (if different from to whom the check is written) and address:
N/A

If applicable
Adjudicator Information

List the name & honorarium owed for each adjudicator: Large Ensemble MPA's - Adjudicators are paid $35 per ensemble they adjudicate. Solo & Small Ensemble MPA's - Adjudicators are paid $35 per hour prorated to the half hour
Adjudicator Name 1
N/A

Required First Required Last
Honorarium Amount to Adjudicator 1 USD *
N/A
Travel Stipend Amount Owed - If Applicable USD *
N/A

Please use the info below to determine if mileage should be provided: 0-49 miles traveled one way-No Reimbursement 50-99 miles traveled one way-$25 total 100-149 miles traveled one way-$50 total 150+ miles traveled one way-$75 total
Adjudicator 1 Mailing Address: *
N/A
Adjudicator Name 2
N/A

Required First Required Last
Honorarium Amount to Adjudicator 2 USD *
N/A
Travel Stipend Amount Owed - If Applicable USD *
N/A

Please use the info below to determine if mileage should be provided: 0-49 miles traveled one way - No Reimbursement 50-99 miles traveled one way - $25 total 100-149 miles traveled one way - $50 total 150+ miles traveled one way - $75 total
Adjudicator 2 Mailing Address: *
N/A
Adjudicator Name 3
N/A

Required First Required Last
Honorarium Amount to Adjudicator 3 USD *
N/A
Travel Stipend Amount Owed - If Applicable USD *
N/A

Please use the info below to determine if mileage should be provided: 0-49 miles traveled one way - No Reimbursement 50-99 miles traveled one way - $25 total 100-149 miles traveled one way - $50 total 150+ miles traveled one way - $75 total
Adjudicator 3 Mailing Address: *
N/A
Adjudicator Name 4
N/A

First Last

If applicable
Honorarium Amount to Adjudicator 4 USD
N/A

If applicable
Travel Stipend Amount Owed - If Applicable USD *
N/A

Please use the info below to determine if mileage should be provided: 0-49 miles traveled one way - No Reimbursement 50-99 miles traveled one way - $25 total 100-149 miles traveled one way - $50 total 150+ miles traveled one way - $75 total
Adjudicator 4 Mailing Address: *
N/A
Adjudicator Name 5
N/A

First Last

If applicable
Honorarium Amount to Adjudicator 5 USD
N/A

If applicable
Travel Stipend Amount Owed - If Applicable USD *
N/A

Please use the info below to determine if mileage should be provided: 0-49 miles traveled one way - No Reimbursement 50-99 miles traveled one way - $25 total 100-149 miles traveled one way - $50 total 150+ miles traveled one way - $75 total
Adjudicator 5 Mailing Address: *
N/A
Adjudicator Name 6
N/A

First Last

If applicable
Honorarium Amount to Adjudicator 6 USD
N/A

If applicable
Travel Stipend Amount Owed - If Applicable USD *
N/A

Please use the info below to determine if mileage should be provided: 0-49 miles traveled one way - No Reimbursement 50-99 miles traveled one way - $25 total 100-149 miles traveled one way - $50 total 150+ miles traveled one way - $75 total
Adjudicator 6 Mailing Address: *
N/A
Adjudicator Name 7
N/A

First Last

If applicable
Honorarium Amount to Adjudicator 7 USD
N/A

If applicable
Travel Stipend Amount Owed - If Applicable USD *
N/A

Please use the info below to determine if mileage should be provided: 0-49 miles traveled one way - No Reimbursement 50-99 miles traveled one way - $25 total 100-149 miles traveled one way - $50 total 150+ miles traveled one way - $75 total
Adjudicator 7 Mailing Address: *
N/A
Adjudicator Name 8
N/A

First Last

If applicable
Honorarium Amount to Adjudicator 8 USD
N/A

If applicable
Travel Stipend Amount Owed - If Applicable USD *
N/A

Please use the info below to determine if mileage should be provided: 0-49 miles traveled one way - No Reimbursement 50-99 miles traveled one way - $25 total 100-149 miles traveled one way - $50 total 150+ miles traveled one way - $75 total
Adjudicator 8 Mailing Address: *
N/A
Adjudicator Name 9
N/A

First Last

If applicable
Honorarium Amount to Adjudicator 9 USD
N/A

If applicable
Travel Stipend Amount Owed - If Applicable USD *
N/A

Please use the info below to determine if mileage should be provided: 0-49 miles traveled one way - No Reimbursement 50-99 miles traveled one way - $25 total 100-149 miles traveled one way - $50 total 150+ miles traveled one way - $75 total
Adjudicator 9 Mailing Address: *
N/A
Adjudicator Name 10
N/A

First Last

If applicable
Honorarium Amount to Adjudicator 10 USD
N/A

If applicable
Travel Stipend Amount Owed - If Applicable USD *
N/A

Please use the info below to determine if mileage should be provided: 0-49 miles traveled one way - No Reimbursement 50-99 miles traveled one way - $25 total 100-149 miles traveled one way - $50 total 150+ miles traveled one way - $75 total
Adjudicator 10 Mailing Address: *
N/A
A completed IRS W-9 Form (https://www.irs.gov/pub/irs-pdf/fw9.pdf) is needed for each adjudicator this is the first event for which they have adjudicated this year. Please check with Kelly Gressley (kelly@pmea.net) to confirm if a W-9 is needed for any of your adjudicators.

If needed, completed forms can be emailed to Kelly or uploaded via the field below.
Completed W-9 forms for Adjudicators (if applicable):
N/A
Upload file
Up to 5 files may be uploaded
Thank you for completing the Host Expense Form. Hosts & Adjudicators will receive payment from PMEA within two weeks of submission of this form. *Please be sure to also complete the MPA Host Assessment Form https://zfrmz.com/i0a0uHkDMZ7OMvj4LNiB

2025 MPA Host Expense Report Form

Host Honorarium

Host Hospitality Expenses

Other Expenses

Adjudicator Information

Error Occurred

Link to resume this form later:

Turn on the camera permission in your browser to continue further