EFTA Document EFTA01650144

Yes, my support person will require separate n No, my support person will not require separate lodging lodging If bringing a support person, will your support person require airport transportation? o Yes, my support person will require transportation to/from the airport o No, my support person will not require transportation to/from the airport Acknowledgement and Signature By checking and signing below, I acknowledge I have read and understand that only lodging, lodging taxes, mileage, and commercial transportation expenses (airfare, bus, train, and hotel transportation only) will be authorized as outlined above. I understand that the following will not be included/provided in the authorized expenses: meals, rental vehicle, entertainment, or other incidental charges. fi Yes, I acknowledge the above statement Click here to enter Your full name Click here,to enter signature date 1 3 EFTA01650144