CONFIDENTIAL WHEN COMPLETED
(over)
FORM REG/GAM 5443 (2016 Feb)
This for
m may be obtained from our website:
www.aglc.ca
TRAVEL ITI
NERARY
THIS FORM
MUST BE SUBMITTED AND APPROVED
BEFORE GAMING PROCEEDS CAN BE USED FOR TRAVEL OUTSIDE ALBERTA
For trav
el outside of Canada, the group must demonstrate a similar
activit
y does not exist in Canada.
Eligible
tr
avel in Alberta does not require the submission of a Travel
Itinerary
Form.
Note:
The travel must be required for the group to deliver its
programs in Alberta.
Travel that is social, recreational or
administr
ative in nature is not eligible.
A Requ
est to Amend Use of Gaming Proceeds form is not
required when submitting a Travel Itinerary form.
Return
this form to:
Alberta Gaming & Liquor Commission Social
Responsibility & Licensing/Compliance Use
of Proceeds
50 Corriveau Avenue
St.
Albert, AB T8N 3T5
Main: 780-447-8600
Use of Proceeds Line: 780-651-7600
Toll-Free: 1-855-506-1066
Fax: 780-447-8912
O
RGANIZAT
ION
N
AME
Name: I.D.#:
Address:
City/Tow
n
Postal Code
SIGNING AUTHORITIES
WE CERT
IFY THAT: all information and documents supplied are correct, and the group has authorized us to make this request
Any AGLC Inspector may examine and make copies of all records relating to this request
and/or licence. This includes the
approved bank account(s) at any financial institution(s).
Preside
nt Signature:
P
r
i
nt
F
ul
l Name:
D
at
e
of
B
i
rth:
yy mm dd
Mai
l
i
ng A
ddr
es
s:
Postal Code
Residence P
hone: Business Phone: Fax: Email:
( ) ( ) ( )
Treasurer
Signature:
Print Ful
l Name:
Date of Bi
rth:
yy mm dd
Mailing Addres
s:
Postal Code
Residence P
hone: Business Phone: Fax: Email:
( ) ( ) ( )
E
VENT
Name:
Destinat
ion: Dates:
Describe
the activity/event: