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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:
Email: [email protected] website: www.aglc.ca