229810 03/12/14 r C�N..
�' �`"' CITY OF CARMEL, INDIANA VENDOR: 356912
�, � .
•j, e ''r ONE CIVIC SQUARE AMERICAN SOCIETY OF CIVIL ENGINEEI$$�ECK AMOUNT: S"'""'168.75"
�:, ;�Q CARMEL, INDIANA 46032 P.O.80X 79084 CHECK NUMBER: 229810
�'M,�,oN�" BALTIMORE MD 21279-0084 CHECK DATE: 03/12I14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2200 4355300 168.75 ORGANIZATION & MEMBER
'� t��� �' Warltl Headquarters
1801 Alexander Bell Drive,Reston VA 20191-4382 USA
�� �� � � ��j���� Phone:(800)54Ema 13 mem6er@ sce.org FWeh(70wwwasce org
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ANiERICAN SOCIETY OF CIVIL ENGWEERS
Official Membership Authorization Receipt Instructions to Recipient: �ProfessiOnal LiCensure
Complete items 1-6 �Registered Engineer ❑Not licensed
Q Deliver to Addressee Only 3 76�>> ❑Registered Land Surveyor ❑Engineer-in-Training
Mr.Jeremy Michael Kashman �Licensure not available in ❑Land Surveyor-in-Training
American Structurepoint, Inc. residence area
Ste. 100 Primary state/country �D��i�l�
7260 Shadeland Sta. Reg.#: � �D1�i0�t��?'� Exa.Date:3�I:, Z-Gj�
Indianapolis, IN 462�6-3977
Invitation Code: 0114CB26 � Your ASCE mem6ership includes membership in one ASCE specialty Institute. Please
check the one you would like to became enrolled in.
� � Yes,activate my membership! l understand my 201� dues ❑Architectural Engineering Institute(AEI)
are discounted 25%,a savings of up to$56.25. Plus 1 may join ❑Coasts,Oceans,Ports and Rivers Institute(CUPRI)
the specialty Institute of my choice. ❑Construction Institute(CI)
Your reduced dues are shown below. Please indicate your ❑Engineering Mechanics Institute(EMI)
Institute membership in section 4 of this form. ❑Environmental and Water Resources Institute(EWRI)
You may also join online at www.asce.org/join and use your ❑Geo-Institute(6-I)
personal invitation number—01 14CB26—when prompted. ❑Structural Engineering Institute(SEI)
❑Please remove me from your mailing list. �Transportation and Development Institute(T&DI)
❑No,I do not wish to become an ASCE member at this time,but please keep me on Signature
your mailing list. If elected,I will conform to the Canstitution,Bylaws,Rules of Policy and Procedures,
❑Check here if you are already a member of ASCE.You received this mailing and Code of Ethics of ASCE as stated at www.asce.org/membergrades. Your
because we were unable to match your name and address,as it appears on this membership cannnt be activated until Constitution,Bylaws,Rules of Policy,
form,with your membership record.Please return this form to us and we will Procedures and Codes of Ethics is signed.
correct this error.Indicate any corrections to your work or home address below.
Have you ever been a member of ASCE? ❑No �jYes Signature: Date: � l� 1
Date of Birth: ►aov�� 1S 1`t.��
montn oay Year � Calcula Your Dues
Gender: f�Male ❑Female ❑Prefer not to say Please calculate your dues based on the dues schedule below.
Far a more complete description of ASCE mem6er grades,visit www.asce.orglmembergrades.
Please send my ASCE correspondence to my ❑Residence ❑Work Place
Residence Address: (1) Mem6ers,Assaciate Members,and Affiliate Members
(not recent BS grads):°'n�zz"vo $168.75
Street �3I C. � �:�5c� �vz.. ��i�- 3�2 (2)Associate Members and Affiliate Members who are recent recipients of
Ciry/State/Zip '-sLur-c-, T.n� `{��3� a Bachelor's degree are entitled to a sliding dues schedule.Dues are based
upon the year the Bachelor's degree was granted:
Phone 3t � -2$t - [`3`�1"/ Year of graduation:�§A-BA $37.50
Email First year after receipt of Bachelor's degree:�§8:8A $37.50
Employer: Second year after receipt of Bachelor's degree:$8r99 $63.75
Third year after receipt of Bachelo�'s degree:$�88 $93.75
Company Name C;� �� �r+�w�, � Fourth year after receipt of Bachelor's degree:$�,r.89 $131.25
Job Title C;� �q t r1�-r Fifth year after receipt of Bachelnr's degree and thereafter: '$168.75
Street I (���c ���+r.,�-e ❑ Please charge my: ❑V'isa ❑American Express ❑MasterCard ❑Discover mers Club
Ciry/State/Zip �,��,�,a� '� 1{��U.s 7 Card Numher oaoo-aooa-�000-0000
Phone 31� - ��� -Zyy f Fax 3[� -5-7( -2tf-39 Expiration Date ���00 pmount$
Email '1�CccS��vi u cn C C'c.r►'K.�I.;n����v'
�Signature: Date:
Educational Background ❑Check here if no degree. ❑My check for$ is enclosed,payable to ASCE in U.S,dollars payable
Undergraduate Degree: Major G;�!;l �Q�,���.;�n�� through a U.S.bank.
College/University Q--o S.z-N-J�,;M.t;✓� � ❑ BILL ME.Please use my: ❑Residence address ❑Employer address
Graduation Date(month/year) �� '?�✓��
Graduate Degree: Major For Office Use Only
Educ❑ Resume❑ Date Rcvd MARC
College/University Registration❑ Refs.❑ Ballot❑
Graduation Date(month/year) Date Grade
0114CB26 0114R
Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom,
rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
American Society of Civil Engineers Purchase Order No.
POB 79084 Terms
Baltimore, MD 21279-0084 Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s) Amount
1/0/1900 0 ASCE Membership-Jeremy $ 168.50
Total $ 168.50
I hereby certify that the attached invoice(s), or bill(s), is (are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6.
,20
Clerk-Treasurer
VOUCHER NC WARRANT NO.
American Society of Civil Engineers ALLOWED 20
POB 79084 IN SUM OF $
Baltimore, MD 21279-0084
� ��. o' l��?�
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or �NVOICE NO. ACCT#/TITL AMOUNT
�EPTa . I hereby certify that the attached invoice(s),
0 0 22oo-assssoo $ .�se� or bill(s) is (are) true and correct and that the
-7 materials or services itemized thereon for
`6� !�l' which charge is made were ordered and
received except
3/10/2014
Signature
City Engineer
Cost Distribution ledger classification if Title
claim paid motor vehicle highway fund