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 ABCDEFGH
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2      Henry M. Jackson High School 
3      1508 136th Street SE | Mill Creek, WA 98012 
4  ASB Meals Phone (425) 385-7000 § Fax (425) 385-7044 
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7  Sport/Event/Club:   
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9     Advisor/Coach responsible for distributing funds:  
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11  Date(s) of Event:    
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13  Travel Location:  
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15 Student Name (print) Breakfast $5.00 Lunch $8.00 Dinner $12.00 Total Amt. Received Student Signature 
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41 By signing, I agree that I have received the dollar amount noted for my meal per diem. 
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43   Total Distributed: (calculate at conclusion of event)  
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45   Amount of Advance:   
46  Balance, if any, to be returned to ASB Treasurer the first working day upon return from the event. 
47  Difference: 
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