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COSTS (e.g. per diem, taxi, etc)TRANSPORTATION (air fare economy)Registration Fee: Costs: TOTAL:  SOURCE OF FUNDINGACCOUNT NUMBERFUNDS REQUESTEDADVANCE REQUESTEDADVANCE AMOUNT% TPDA $% YES % NO$% Research/Travel Account$% YES % NO$% Other (specify)$% YES % NO$ If an advance against TPDA is requested, please forward this form to your Faculty Dean s Office. 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