252674 12/15/15 CITY OF CARMEL, INDIANA VENDOR: 362435
® it ONE CIVIC SQUARE INDIANA SECTION AWWA CHECK AMOUNT: $""""""*100.00"
CARMEL, INDIANA 46032 5265 E 82ND STREET SUITE 310 CHECK NUMBER: 252674
INDIANAPOLIS IN 46250 CHECK DATE: 12/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 SPEARS 100.00 OTHER EXPENSES
108th Annual Meeting
EMMA SECTION AWWA
Marriott Hotel—Indianapolis,IN
January 25-28,2016
GIST R ATI F
A L L A T T E N D E E S
Utility
❑ Service Provider z p/,,
NAME:— SAS OI f�S /y�J� �^ 0 a 4 G`�
(only one name per form) AWWA MEMBER#: L
Leal First Initial
TITLE: ORGANIZATION: �i o�C.tn ,�c Gy�fr
ADDRESS: M60 w • 131 1¢ St,
CITY 1 STATE/ZIP: eAAK4 4,L � 4/•
OFFICE TELEPHONE:(, 317 )- 73 3- 2 8 5 FAX: ( 3/7 733- ,2053
EMAIL:
REGISTRATION FEES The
ADVANCE registration
ri,
Full conference-member* ❑ Advance:$125 ❑ On-site:$185 J&m 8t 2016
Full conference-non-member* ❑ Advance:$215 ❑ On-site:$265
One day-member* Advance:$100.: ❑ On-site:$135 Day:
One day-non-member* ❑ Advance:.$195 ❑ On-site:$230 Day:
*A$10.00 fee will be charged for all on-site name changes_on pre-registration name badges.(Service Providers Only)
COMPLIMENTARY REGISTRATIONS
❑ Student,full-time ❑ Retired(AWWA members only)
❑ Guest(Admittance to receptions only) Name:
❑ First time attendee 1 Haven't Attended in At Least 5 Years (UTILITY REGISTRANTS ONLY)
EARLY BIRD REGISTRATION
Monday,Jan.25,3:00-7:00 p.m.
MEALS-Tickets required
❑Tuesday,Jan.26,12-noon:Keynote luncheon-$25
❑Wednesday,Jan.27, 12-noon:Awards luncheon-$25
❑Thursday,Jan.28,7:30 a.m.:Breakfast-$15
T tal Amount Enclosed:$ Returnthis completed form with payment to the address below.
-( Check made payable to Indiana Section AWWA is enclosed. (Check no.: )
❑ Please charge to my: ❑Visa ❑MasterCard o American Express ❑Discover
Name as it appears on card: Signature:
s
Billing address:
Card number: Exp,date: Security Code:
ONLY ONE NAME PFR SPECIAL NEEDS RERM POLICY RETURNCOMPLETED
FORM,PLE40 Every reasonable effort will be You can recover your pre-pay- FORM TO:
Photocopy the registration made to accommodate special ment by written request,post- Indiana Section AWWA
form for use by others needs. Please contact marked no later than Jan.4, 5265 E.82nd Street,#1310
or go to our web site Dawn Keyler at(866)213-2796 2016,to Dawn Keyler. Indianapolis;IN 46250
for additional forms. or dawn.keyler@inawwa.org Request for refunds made after Office:(866)213-2796
www.inawwa.org with your request. that date cannot be-honored. FAX:(866)215-5966
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
155109
AWWA* Purchase Order No.
Dept 0064 Terms
Denver, CO 80256 Due Date 12/10/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/10/201! SPEARS $100.00
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
Date Officer
VOUCHER # 153806 WARRANT# ALLOWED
155109 IN SUM OF $
D�4 �
������ �/
ar�WWa�ter UP/
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
SPEARS 01-6040-05 $100.00
Voucher Total $100.00 '
Cost distribution ledger classification if
claim paid under vehicle highway fund