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HomeMy WebLinkAbout252381 1 2/08/1 5 4�"\( CITY OF CARMEL, INDIANA VENDOR: 353634 •,4 ONE CIVIC SQUARE PENNWELL REGISTRATIONS CHECK AMOUNT: $*****1,310.00* CARMEL, INDIANA 46032 EMS TODAY 2016 CHECK NUMBER: 252381 PO BOX 973059 CHECK DATE: 12/08/15 DALLAS TX 75397-3059 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4357004 1,310.00 EXTERNAL INSTRUCT FEE \. EMS U� FEBRUARY 25727 2016 � y TO Y Baltimore Convention Center TM Baltimore;Maryland EAR .. an t� First Name M Last Name T�Oul e --j 4 WAYS TO REGISTER: QI 1obTitle'a'12415 jple° lG ,— IC, Organization ° � � ' '� Online:1. Address 1 � J►e 5�7 2.Email: Address 2 Registration@ pe City Ce�r�"�� I State/Province I^j Postal Code o37 (US Only)888-299-8057 Country y +1-918-831-9161S i PennWell Registration/EMS Today 2016 Telephone(+) �� � � �'�'© � Fax(+) PO :.x 973r r Emailr11��CCr''�Q.� Dallas, i 59 USA Your individual email address is required—confirmation is sent via email and is needed for CEH certificate login. If you have multiple licensees or an NREMT#,please contact registration via phone or email. q Certification/License M t n 18 Q IG 19 6 License State: I�"� p Date of Birth: License Type(E.G.,EMT-B,EMT-P)(%MT_ R License Category(BLS,ALS,or Other) PLS License Expiration Date: 03 31 I-) PROMO CO What's this?Promo codes are on dirkt mail pieces, e .e a o provide attendeesdiscounts eer specialoffers. ® LL 1 e 1.OCCUPATION/POSITION(CHOOSE ONLY 1) 2. EMPLOYER/AFFILIATION(CHOOSE ONLY 1) 3. PURCHASING ROLE ,KA. Paramedic ❑ 1. Hospital (CHOOSE ALL THAT APPLY) ❑ B. EMT Basic ❑ 2. Private Ambulance ❑ FA Purchase ❑ C. EMT-I,EMT-D 3. Volunteer Fire Dept./Rescue Squad ❑ FB Approve ❑ D. First Responder 4. Paid Fire Dept./Rescue Squad ❑ FC Recommend ❑ E. Emergency/Public Safety Manager ❑ 5, Combination Fire Dept./Rescue Squad ❑ FD Specify ❑ F. Physician ❑ 6. Third Service/Municipal Agency FE Influence ❑ G. Medical Director ❑ 7. Industrial/Commercial ❑J. Registered Nurse ❑ 8. Educational Institution ❑ K. Instructor/Coordinator/Trainer ❑ 9. Military/Government ❑ L. Administrator/Supervisor ❑ 10.Other ❑ M.EMS Chief ❑ N. Fire Chief ❑ P. Other Chief ❑ R. Pres,Dir,CEO,VP,Mgr ❑ S. Captain/LUCommander/Other Officer ❑T. Student ❑ 0. Other(Specify) Penn ell EVENT REGISTRATION . . p""k`,." � Silver Passport(2-Day) .......................................... Early-Bird:$320.......................................Regular:$420 Single Day Full Conference........................................ Early-Bird:$205.......................................Regular:$305 Exhibitor Full Conference......................................... Early-Bird:$175.......................................Regular:$175 Exhibit Hall Visitor Only.......................................... Early-Bird:$30...............................,..,.....Regular:$40 PRE-CONFERENCE WORKSHOPS Please select the Pre-Conference Workshop you would like to attend and add the price to your registration total.All are at a first-come,first-served basis.Lunch is included with all 8-hour(full day)workshops and two,4-hour(half day)workshops. Early Bird Rates expire:January 15,2016 WEDNESDAY, FEBRUARY 24,2016 HALF-DAY WORKSHOPS FULL-DAY WORKSHOPS ❑ Boosting Your Organization's Recruitment,Retention&Reputation Active Shooter Simulation Lab 8:00AM—12:OOPM or 1:00PM—5:OOPM 8:OOAM—5:OOPM Early Bird:$125.00 Regular:$150.00 Early Bird:$215.00 Regular.$240.00 - ❑EMT"Design It Yourself'Refresher Workshop 8:00AM—12:OOPM or 1:OOPM—5:OOPM ❑ Community Paramedicine Preconference Workshop Early Bird:$125.00 Regular:$150.00 8:OOAM—5:OOPM ❑ NEMSMA's Pressing Topics in EMS Management Early Bird:$215.00 Regular:$240.00 8:00AM—12:OOPM Early Bird:$125.00 Regular:$150.00 ❑ EMS Compass Town Hall Meeting:How Performance Measures Could Transform EMS 8:OOAM—5:OOPM ❑ Self Defense Tactics for EMS Providers Early Bird:$215.00 Regular:$240.00 8:OOAM—12:OOPM or 1:00PM—5:OOPM Early Bird:$125.00 Regular:$150.00 ❑ Cadaver Lab LUNCH&LEARNS 1:OOPM—5:00PM ❑ Medtronic Lunch&Learn Early Bird:$75.00 Regular:$75.00 A Critical New Role for EMS in Improving Stroke Outcomes ❑ Emergency Medical Response to the Active Shooter Thursday,February 25,2016 12:OOPM—1:30PM............................Fee:$10 1:OOPM—5:OOPM Early Bird:$125.00 Regular:$150.00 ❑ Zoll Lunch&Learn Friday,February 26,2016 12:OOPM—1:30PM............................Fee:$10 More People = More Savings! Price. Early Bird Rate- Regular Rate Amount of people Price. Name of reg type before 1/15/16 after 1/15/16 ® $275 $325 3-5 $1,000 CODE ALPHA �• '• $200 $250 6-10 $2,000 CODE BRAVO 11+ $2,500 CODE CHARLIE . " 1-Year subscription to JEMS($44 Value)Please u ,.;... check Your registration fee includes a 1-year print subscription to JEMS magazine. a •ide Along opportunities availab.le. ElCheck here if you do not wish to receive JEMS. All ate complimentary. You will not be refunded the subscription rate. TOTALPAYMENT METHOD OF PAYMENT " Please add all selections $ �� 5 Payment must be received prior to conference ❑Check Enclosed(U:S.funds only.Checks payable fo PennWell/EMS Today 2016) and total here: - ❑Wire Transfer(wirin .i.nfo provided upon,confirmation) ❑.Credit Card: PROMO CODE: ❑Amex ❑Visa p MasterCard El Discover ❑Diners Club Payment must-be received by published date to.receive early registration discounts. Card Number Cancellations must be received in writing by February 8:2016 to receive a refund minus. Exp.Date PCTlll �ll a$75.00 administrative fee..No REFUNDS will:be.permitted after February 13,2016. Name on Card jSubstitutions may be made at any time by written notification to the registration office. Signature -�m EMs FEBRUARY 25 .27 2016 r � . TODAY/: . Baltimore Convention Center L' Baltimore, Maryland c-Ea SErarerv0VEA First Name r�,;,3 Last Name 4 WAYS TO REGISTER: Job Titlet) 1.Online: tS �� C �C �S Organization_ Cc''M C �1�CQ�— Address 1 of G v'I C �& ' Address 2 Registratione / e • City ��CM+ State/Province ' Postal Code `l�i rj888-299-8057 Country USP +1-918-831-9161 Telephone(+) 3) J Z(�oo Fax(+) PennWell Registration/EMS Today r 16 •O Box 973059, Email � Cd:rr16t l , 1t1 t J DallasTX r 59 USA Your individual email address is required–confirmation is sent via email and is needed for CEH certificate login. If you have multiple licenses or an NREMT#,please contact registration via phone or email. Certification/License#: 13u 7– B7S­5' License State: Date of Birth: License Type(E.G.,EMT-B,EMT-P) License Category(BLS,ALS,or Other) Lj License Expiration Date: )0 0 1 L PROMOCODE* *What's this?Promo codes are on direct.mail pieces,emails and aclvertisem�nts.They.are used to prqvide attendees vvith�discounts ahcllwspecial offers. LE A NSWE:R:THEi1FQLL0 INP / 1 1. OCCUPATION/POSITION(CHOOSE ONLY 1) 2. EMPLOYER/AFFILIATION(CHOOSE ONLY 1) 3. PURCHASING ROLE A. Paramedic ❑ 1. Hospital (CHOOSE ALL THAT APPLY) In B. EMT Basic ❑ 2. Private Ambulance ❑ FA Purchase ❑ C. EMT-I,EMT-D ❑ 3. Volunteer Fire Dept./Rescue Squad ❑ FB Approve ❑ D. First Responder 4. Paid Fire Dept./Rescue Squad ❑ FC Recommend ❑ E. Emergency/Public Safety Manager F 5. Combination Fire Dept./Rescue Squad ❑ FD Specify ❑ F. Physician ❑ 6. Third Service/Municipal Agency FE Influence ❑ G. Medical Director ❑ 7. Industrial/Commercial ❑J. Registered Nurse ❑ B. Educational Institution ❑ K. Instructor/Coordinator/Trainer ❑ 9. Military/Government ❑ L. Administrator/Supervisor ❑ 10.Other ❑ M.EMS Chief ❑ N. Fire Chief ❑ P. Other Chief ❑ R. Pres,Dir,CEO,VP,Mgr ❑ S. Captain/LtICommander/Other Officer ❑T. Student ❑ 0. Other(Specify) Peell V Silver Passport(2-Day) .......................................... Early-Bird:$320.......................................Regular:$420 Single Day Full Conference........................................ Early-Bird:$205.......................................Regular:$305 Exhibitor Full Conference......................................... Early-Bird:$175.......................................Regular:$175 Exhibit Hall Visitor Only.......................................... Early-Bird:$30........................................Regular:$40 PRE-CONFERENCE WORKSHOPS Please select the Pre-Conference Workshop you would like to attend and add the price to your registration total.All are at a first-come,first-served basis.Lunch is included with all 8-hour(full day)workshops and two,4-hour(half day)workshops. Early Bird Rates expire:January 15,2016 WEDNESDAY, FEBRUARY 24,2016 HALF-DAY WORKSHOPS FULL-DAY WORKSHOPS LA ❑ Boosting Your Organization's Recruitment,Retention&Reputation Active Shooter Simulation Lab 8:00AM—12:OOPM or 1:OOPM—5:OOPM 8:00AM—5:OOPM Early Bird:$125.00 Regular:$150.00 Early Bird:$215.00 Regular:$240.00 ❑EMT"Design It Yourself'Refresher Workshop 8:OOAM—12:OOPM or 1:OOPM—5:OOPM ❑ Community Paramedicine Preconference Workshop Early Bird:$125.00 Regular:$150.00 8:OOAM—5:OOPM ❑ NEMSMA's Pressing Topics in EMS Management Early Bird:$215.00 Regular:$240.00 8:00AM—12:OOPM Early Bird:$125.00 Regular:$150.00 ❑ EMS Compass Town Hall Meeting:How Performance Measures Could Transform EMS 8:OOAM—5:OOPM ❑ Self Defense Tactics for EMS Providers Early Bird:$215.00 Regular:$240.00 8:OOAM—12:OOPM or 1:OOPM—5:OOPM Early Bird:$125.00 Regular.$150.00 ❑ Cadaver lab LUNCH&LEARNS 1:OOPM-5:OOPM ❑ Medtronic Lunch&Learn Early Bird:$75.00 Regular:$75.00 A Critical New Role for EMS in Improving Stroke Outcomes ❑ Emergency Medical Response to the Active shooter Thursday,February 25,2016 12:OOPM—1:30PM............................Fee:$10 1:OOPM—5:OOPM Early Bird:$125.00 Regular:$150.00 ❑ Zoll Lunch&Learn Friday,February 26,2016 12:OOPM—1:30PM............................Fee:$10 [ CREW PRICING More People = More Savings!p g Price Early Bird Rate- Regular Rate- Amount.of people Price Name of reg type before 1115116 after 1/15/16 '• $275 $325 3-5 - $1,000 CODE ALPHA $200 $250 16-10 $2,000 CODE BRAVO 11+ $2,500 CODE CHARLIE 1-Year subscription to JEMS($44 Value) Your registration fee includes a 1-year Please check • • of print subscription to JEMS magazine.Ride Along opportunities available. ` ❑ Check here if you do not wish to receive JEMS. All are complimentary. You will not be refunded the subscription rate. TOTAL PAYMENT DUE METHOD'OF PAYMENT ' Please add all selections $ S Payment must be received prior to conference - and total here: - ❑ Check,Enclosed(U.S.funds only.Checks payable to PennWell/EMS Today 2016) ❑Wire Transfer(wiring info provided upon confirmation) ❑.Credit Card: PROMO CODE: ❑Amex ❑Visa ❑MasterCard ❑Discover ❑Diners Club Payment must be received by published date to receive,early.registration discounts. Card Number Cancellations must be received:in.writing by February8,.2016 to receive a refund minus Exp.Date P ... a$75:00 administrative fee.NO"REFUNDS will be permitted after February.8;2016. Name'on"Card _VW1�ellll Substitutions may be made at any time by written notification to the registration office. Signature VOUCHER NO. WARRANT NO. Pennwell Registrations ALLOWED 20 EMS Today 2016 IN SUM OF $ PO Box 973059 Dallas, TX 75397-3059 i $1,310.00 i ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members 1120 43-570.04 $655.00 1 hereby certify that the attached invoice(s), or 1120 43-570.04 $655.00 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 DEC _ 7 2915 t 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. I Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Benbow $655.00 Fagin $655.00 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