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242235 02/17/15 CITY OF CARMEL, INDIANA VENDOR: 368009 ONE CIVIC SQUARE CITY OF LEWISVILLE CHECK AMOUNT: $"'*"*"280.00* s r° CARMEL, INDIANA 46032 KTA SYMPOSIUM CHECK NUMBER: 242235 PO BOX 299002 CHECK DATE: 02/17/15 LEWISVILLE TX 75029-3704 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4357004 280.00 EXTERNAL INSTRUCT FEE Print and Mail Completed Form To Address Below. You can fill this out scan and email it to me if you wish to pay via credit card. I will call you to complete the registration. 2015 ITA Symposoum RegoBtraflon The 2015 Registration fee for KTA is$70 per attendee. Checks can be made payable to City of Lewisville. If you wish to pay via credit card we can accommodate you. If you wish to use a credit card please include a daytime phone number and I will contact you to get the necessary information. YOU WILL NOT BE REGISTERED UNTIL WE RECEIVE YOUR PAYMENT! Each participant MUST complete the form. Please choose between Pipes and Drums or Honor Guard, but not both. Name Thomas Payne Department Name Carmel Fire Department Department City City of Carmel Department State Indiana Cell Phone 317 407-6550 Email Address t a ne44 comcast.net Please Circle the appropriate response: What are you signing up for (Please Only Choose One) Honor Guard Honor Guard Commander Team Member Pipes Beginner Intermediate Advanced Drums Snare Tenor Bass Beginner Intermediate Advanced Will you require transportation from the airport Yes No We are happy to provide transportation to and from DFW or Dallas Love Field. We will require your complete itinerary for arrival and departure flights. We also need a cell phone number that you will have with you while traveling to coordinate your transportation. _ Flight Information Arrival Airline Flight Number Arrival Date and Time I DepartdW Airline Flight Number \��p Departure Date and Time v (wail completed registration and payment to: Lewisville Fire Department Attn: KTA Symposium PO Box 299002 Lewisville, TX 75029-3704 Office 972-219-3590 Fax 972-219-3704 Email Address: tmcgrath@cityoflewisville.com Print and Mail Completed Form To Address Below. You can fill this out scan and email it to me if you wish to pay via credit card. I will call you to complete the registration. 20` 15 KTA S'__""'ymposoum Rl%eg �strafion The 20.15 Registration fee for KTA is$70 ver attendee. Checks can be made payable to City of Lewisville. If you wish to pay via credit card we can accommodate you. If you wish to use a credit card please include a daytime phone number and I will contact you to get the necessary information. YOU WILL NOT BE REGISTERED UNTIL WE RECEIVE YOUR PAYMENT! Each participant MUST complete the form. Please choose between Pipes and Drums or Honor Guard, but not both. Name G S C— Department Name C LL ie L �—< �G�IL 11 L I fv\-C-Lit Department City j ku b v Department StateA Cell Phone 9T-6­75 Email Address Y \\1 OS kv 0 0'r-me \'J Please circle the appropriate response: What are you signing up for (Please Only Choose One) Honor Guard ,__� Honor Guard Commander ---Team Member Pipes Beginner Intermediate Advanced Drums Snare Tenor Bass Beginner Intermediate Advanced Will you require transportation from the airport 0YesNo We are happy to provide transportation to and from DFW or Dallas Love Field. We will require your complete itinerary for arrival and departure flights. We also need a cell phone number that you will have with you while traveling to coordinate your transportation. Flight Information Arrival Airline Flight Number Arrival Date and Time Departur Airline \\a� Flight Number Departure Date and Time Mail completed registration and payment to: Lewisville Fire Department Attn: KTA Symposium PO Box 299002 Lewisville, TX 75029-3704 Office 972-219-3590 Fax 972-219-3704 Email Address: tmcgrath@cityoflewisville.com I i Print and Mail Completed Form To Address Below. You can fill this out scan and email it to me if you wish to pay via credit card. I will call you to complete the registration. 20"' 15 KTA Sc--"ymposaum R%eg 'Btratbn The 2015 Registration fee for KTA is$70 per attendee. Checks can be made payable to City of Lewisville. If you wish to pay via credit card we can accommodate you. If you wish to use a credit card please include a daytime phone number and I will contact you to get the necessary information. YOU WILL NOT BE REGISTERED UNTIL WE RECEIVE YOUR PAYMENT! Each participant MUST complete the form. Please choose between Pipes and Drums or Honor Guard, but not both. Name Department Name �.` �V;z- �Q Department City Department State Cell Phone Email Address Please circle the appropriate response: What are you signing up for (Please Only Choose One) Honor Guard Honor Guard Commander Team Member Pipes Beginner Intermediate Advanced Drums Snare Tenor Beginner nermed' Advanced Will you require transportation from the airport Yes No We are happy to provide transportation to and from DFW or Dallas Love Field. We will require your complete itinerary for arrival and departure flights. We also need a cell phone number that you will have with you while traveling to coordinate your transportation. Flight Information j Arrival Airline Flight Number Arrival Date and Time j /Departure Airline Flight Number Departure Date and T e Mail completed registration and payment to: Lewisville Fire Department Attn: KTA Symposium PO Box 299002 Lewisville, TX 75029-3704 Office 972-219-3590 Fax 972-219-3704 Email Address: tmcgrath@cityoflewisville.com Print and Mail Completed Form To Address Below. You can fill this out scan and email it to me if you wish to pay via credit card. I will call you to complete the registration. 2015 [STA Symposium rrlZeostration The 2015 Registration fee for KTA is.$70 ver attendee. Checks can be made payable to City of Lewisville. If you wish to pay via credit card we can accommodate you. If you wish to use a credit card please include a daytime phone number and I will contact you to get the necessary information. YOU WILL NOT BE REGISTERED UNTIL WE RECEIVE YOUR PAYMENT! Each participant MUST complete the form. Please choose between Pipes and Drums or Honor Guard, but not both. Name Department Name "Z— Department City Department State Cell Phone -X\� Email Address 1211 Please circle the appropriate response: What are you signing up for (Please Only Choose One) Honor Guard Honor Guard Commander Team Member Pipes Beginner Intermediate Advanced Drums Snare Tenor Bass Beginner Interme iate Advanced Will you require transportation from the airport Yes No We are happy to provide transportation to and from DFW or Dallas Love Field. We will require your complete itinerary for arrival and departure flights. We also need a cell phone number that you will have with you while traveling to coordinate your transportation. Flight Information Arrival Airline / Flight Number / ` Arrival Date and Time / I Departufe Airline / i Flight Number Departure Date and Time / Mail completed registration and payment to: Lewisville Fire Department Attn: KTA Symposium PO Box 299002 Lewisville, TX 75029-3704 Office 972-219-3590 Fax 972-219-3704 Email Address: tmcgrath@cityoflewisville.com 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) $280.00 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 NO. WARRANT NO. ALLOWED 20 -fie I e KTA Symposium gyp" � i3 u`.j�c� IN SUM OF $ PO Box 299002 Lewisville, TX 75029-3704 $280.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 43-570.04 $280.00 1 hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except FEB 1 6 ZU15 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund