248223 08/1 2/1 5 CITY OF CARMEL, INDIANA VENDOR: 010175
ONE CIVIC SQUARE AMERICAN HEART ASSOCIATION CHECK AMOUNT: $*******595.00*
CARMEL, INDIANA 46032 SCIENTIFIC SESSIONS 2015 CHECK NUMBER: 248223
107 WATERHOUSE ROAD CHECK DATE: 08/12/15
BOURNE MA 02532
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4357004 595.00 EXTERNAL INSTRUCT FEE
American
MEMBER ADVANCE SAVE$20TER— Heart
REGISTRATION,fORM _DRB REGISTER ONLINE! A,sociationm
scieftu lesessions org _
SectionContact ' ' S C I E N T I F I C
qq ,,- . SESSIONS
Prehx First M A.(L� _MI ik Lastt VkLLL'FE_--tr_-T Suffix ^O
1115
Nickname for Badge __ Joh TiOe!
Secffon 4,Conference Package r
Please check your member level below:' Scientific Sessions
Nov 7-1/
Early Advance Main
June 3-Sept 9 Sept 10-Oct 7 Oct 840V 11
A Premium Professional Member 5495 _S595 _ $695
AA _Premium Professional Plus Member _5495 S595 S 6
_ 55
B General Professional Member _5750 _S850 $950
C _—_ Premium Emeritus Member S 50 _S100 S 2DO
D Early Career Member _St95 _S595 _$695
E _ Nurse Premium Professional Member S165 _S265 S 365
ES _Nurse Premium Professional Plus Member _$165 _S265 _S 365
F —Nurse General Professional Member $295 =5395 S 495
G Student/Damee Member- ^_$175 E50 _$350
H _MT/Paramedic Premium Prolessional Member $165 _S265 —S 365
HS _✓EMT/Paramedic Premium Professional Plus Member $165 S265 S 365
1 _ EMT/Paramedic General Professional Member _$295 _S395 _$495
J Technician•• ^S165 _S265 _$365
L _Therapist Premium Professorial Member _S165 ____S265 _S 365
LS _Therapist Premium Professional Rus Member S165 S265 _ $365
M Therapist General Professional Member _$295 _S395 _$495
PA Professional Associate Member _$895 __$995 _$11095
•nod 01 rrmim5ip ova re.amsed
099"ftem wrwlf rim SepL a orifi.kd4ads who ImAKAM rues alga eie°aenrp 6Ra Sqt a 7fie do rot 0#d'I to e3•y omr2er re�,emm1 mea nmrstma toss ww roily
E weadaOR=mtoliseaera,w-,OWDefr�i7,2015.kWshxrvd°rWioiiATWni m1A1uexeaa5,pa4bftkn7,28rorotPc4fl'RrRros!SM&MDWaLI roes.NatteiMarocsovaaxil
–mioe a ragsoatlon a mn6rnca,meaner 8ti riarla!erabp SbOtrNba'mee a Trxtadd.'+°must(+rvnde pod d taco wim a aped Grove a caePga¢.awanx A a a letter wntbr on d0dd leC!atamd ab agv9 A a°.F3a OU kad.
mo"a svpcn The her aaefwmbm tee veil be croged 9 scnrraem W not panda M Ucmba 21.201 S.mad m poen 1 la CDS'm aW ema;tl
- - - ation-1T^poise cnm.or.,Exhibit Haft Closed SaWay and Wednesusy
1 Day Options: W ase
C3 SAT_M—Saturday,Nov 7 ❑TUEM—Tuesday,Nov 10 Early Advance Main
SIk9_M—Sunday,fvov 8 ❑WED-M—Wednesday,Nov 11 June 3-Sept 9 Sepl 10-Det 7 oat B-Nav l l
ZI MON h1—MorWay.Nov 9 S4M _S500 —SM
Scientific Sessions: S °u
Er'x)nstructarNumber(marMahuy)D�e t7���o3�-' Scientific Sessions I Day Only: S
Traningfaci& (mandato ) tNLScS 3 Early AWance Maln i ECC Guidelines instructor Conference: $_A
ry ry June 3-Sept 9 Sept 10-0et 7 OR B-Ndv 11
Place an"X"next to the time slot under the workshop you would 5195 _S245 _$205
like to attend.The selection o11 discipline is required before you i Section 4 Registration Total'
can attend the optional workshops.
General Session BLS ACLS PAILS/PEARS Optional Optional
8:30-10 a.m.
10:30-12 p.m. _Flexibility in the Classroom _—Behind the Scenes:Science to Classroom
1:30-3 p.m. _Tech SolutionsTailoring Teaching Styles
3:30-5 p.m. Tech Solutions:International ^Behind the Scenes:Science to Classroom
r3-Sept
Please check the events you'd like to purchase: Special Meal Request
dvance Main _Kosher
10 Oct 7 Oct 9-Nov 11 Oly Saturday Nw 7 _Vegetadan
S65 _S75 CLIN Clinical Cardiology Dinner(7:00 Prv)540 _$45 0.0L Quality of Care 8 Outcomes Research Reception(7:00 rel) _Vegan
_$55 _$65 CLDN —_ Peripheral Vascular Disease Dinner Q:00 ri1) Noire
Monday,Nov 9
_$30 _S30 _$35 CLDA _ Arteriosclerosis.Thrombosis 8 Vascular Biology Women's Leadership llnvdlew(NOON)
_S30 _S30 _S40 GLOB _ Women in Cardiology Networking Luncheon(NOON)
FREE OF CHARGE CLOD .— Cardiovascular Disease in the Young Early Career Luncheon(NOON)
Tuesday,Nov 10
FREE OF CHARGE CLOP _- Arteriosclerosis,Thrombosis and Vascular Biology Council Annual Business Meeting(12:15 ea)
S50 _SSO S60 CIRC _ Basic Cardiovascular Sciences Dinner(7:00,w)
T S50 _S50 _S60 CLDD _ Cardiopulmonary,Critical Care,Perioperative 8 Resuscitation Dinner(7:00 pm)
_S50 _S50 _S60 CLDE e Cardiovascular Radiology 8lntervention Dinner(TDO pa)
--_.$55 _S55 __$65 CLOF Epidemiology 8 Prevention and Lifestylo 8 Cardiornetabdic Health Dinner(7 00 w)
_S55 _S55 —S65 CLOG -- Cardiovascular Disease In The lbtmg Dinner(7:GU eu)
_$55 _S55 _S65 CLDH -` Cardiovascular and Stroke Nursing Dinner(7:00 wt)
_S60 _S60 __$70 CLDK _ Cardiovascular Surgery 8 Anesthesia Dinner(7:00 m)
_$20 _$20 _S25 C LDJ AAenoscierosis,Thrombosis 8 Vascldar Biology Early Career Netvmkinll Reception(7:00 t v)
_S25 _S25 _S30 CLOM Functional Genomics 8 Translational Biology Reception(6:30 Pu)
SOD M_Scientific Sessions OnDemand-Premium(Official Conference Capture of Scientific Sessions) $374(incl.shi ping)
USB_M_USB Add-On Upgrade ,5429(incl.shipping)
Bistro Lunch-$27 for each ticket
Bistro Lunches are pre ordered xunches who will be ready far pick rm when yotc lickct is preseaw in die designated ares.Select whxh dayis).Only 1 ticket pnctwo allowed Per My-
0 Sunday,Nov 8 $_
U Monday,Nov 9 $
❑Tuesday,Nov 10 $ Bistro Lunch Total$ Section 5 Total$
7G.—.d
r Guest baftes allow access to Smamlce and Te chr�logy Hall OOly Nov 8-10(Exhibits closed oR NOv 7 cod New 1t.)
Last
datory)—$70,Junt3-Sept9 K^Advance—SM.SeptID-Oct7 K--Main—$1BO,OctB-MV11y:Guest registration is defined as a shouse or family member of a professional registrant or a guest of an exhibiting company.Guest registrants are rorty permitted in the Science
&
Technology Hall,Nov B No 10.1(yw wish N access the NII meebng,full registration is required.
r , , Please mon,pai merd aerinal C4961 rhos will be CA01 0&MM9,,1214 PayrseM dOO hair Ind"aE rr� a trap,
H oto Arca aniptarr dire rN at)rffin3 av a no[Ca rauary mow 1W W/cowl of ng r Andiat trarnoff brag AHA re nvt
Bre Rant to dwye tes carm:t am0vat.
Section 4 Total: S_
_Check drawn on U.S.bank in U.S.dollars payable to American Heart Association
Sect on 5 Total: S_
_Discover Card _-American Express _MasterCard _VASA _Diner's Club
Section 6 Total: $_ Card number Exp.date
Service Charge:S (Required)
Grand Total: S -
Name as it appears on card Cardholder Signature
VOUCHER NO. WARRANT NO.
ALLOWED 20
American Heart Association
Scientific Sessions 2015 IN SUM OF$
107 Waterhouse Road
Bourne, MA 02532
$595.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 43-570.04 $595.00 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 AUG i 0 2015
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
$595.00
1 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