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Home My WebLink About307759 01/30/17 ��' ��'''•• CITY OF CARMEL, INDIANA VENDOR: 355140 CENTRAL INDIANA ASSOC OF VOLUNTGEWCK AMOUNT: S""""""104.00• ONE CIVIC SQUARE CHECK NUMBER: 307759 CARMEL, INDIANA 46032 ADMINISTRATION PO BOX 732 CHECK DATE: 01/30/17 Mei roH.. INDIANAPOLIS IN 46206-0732 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 4355300 A0000267A 12.00 ORGANIZATION & MEMBER 1125 4355300 A0000267B 17.00 ORGANIZATION & MEMBER 1125 4355300 MEMBERSHIP 75.00 ORGANIZATION & MEMBER « o � % § � ° CA / % Ln U _ o k > / o o � Q� \ k � 3 \ / / 9 j / & S S � B -L 2 $ 2 % N N - m . a X \ > / § m k 7d \ i 0 0 m Z m E k S w w q # > / / / / § : / CD � cn k / 0 o 0 0 ® 7 o t / f [ } � + q k k \ k § -4 \ �¥ q R k R / � ] \ D o = w — £ e f ° co \ < _ . i ] E \ & a l< a \ a - \ c + > -0 5 q 0U ] ¥ k / m m k $ \ / 0 CD ) ƒ km ] e k 2 m 0 k \ / E 2 C) E 0) E & CD w ) ! & & < C) CD CD 9 5 o o q=_ R_ & % a 0 = ° C 2 CD Q 1 TrCIAVA Invoice CIAVA membership lasts for one calendar year. Membership provides access to all member benefits & activities for 12 full months from the date of payment. Annual Full Standard Membership Dues $75.00 Annual Associate Membership Dues (students, retirees, active AmeriCorps, and un-employed only) $35.00 Members Only Prepaid Meeting Package $120.00 (optional) 11 Monthly Meetings for the price of 10 The optional package allows you to issue a single check for Membership dues and meeting fees for your entire membership year. We regret that CIAVA cannot reimburse meeting fees for unattended meetings. Pre-paid meetings are non-transferable. l CIAVA Full Standard Membership(s) $75.00 each $ 75- UU CIAVA Associate Membership(s) $35.00 each $ 1 am a student, retiree, AmeriCorps volunteer, currently unemployed (please circle one) Optional Prepaid Meeting Package $120.00 each $ Total Amount Due $ '7 Please check one: Payment In-process/mailed: or Payment Enclosed: Pricing Valid Through 7/1/16 Your Name - � /tom /y�ZS J -------------e-mail -N � r EzGc�yead eCS.60r>7 If you are purchasing a membership for more than one person, please list all member names here Name: e-mail Name: e-mail Please submil all MemL)ership Applicariotis with payment tee: Ronda Crist, CIAVA Membership Chair CIAVA, P.O. Box 732, Indianapolis IN 46206 www.C1AVA.org For Administrative Use Onl : Date Received Amount Paid Added to www.ciava.or Username/Password Sent Money to Treasurer Receipt/Free Passes Sent CIAVA Membership Application Please print and note that the information below will be used for our website and nametags. Once we have received this application, media release and payment, you will receive your username and password to complete your profile information online. Name �i4�'Yl�L t_� v�Z �� Today's Date I/tel 7 Title / P S 5154 9�i Organization's Name C '- � G' "J Organization's Address: City/State 614--e-ol 0-L zip /`j Work Phone �17'673 yQ3-t(- e-mail Website C,r�,2m -Gt-+�Y�,A S, 90 41 MEDIA RELEASE This Release ("Release") is executed in favor of Central Indiana Association of Volunteer Administration and each and all of its directors, officers, employees, agents, and representatives (collectively, "CIAVA"). I hereby freely and voluntarily execute this Release and agree to the following terms and conditions as a member of the association: MEDIA RELEASE. I grant CIAVA permission to use my name, image, voice, appearance, and likeness for stories or advertisements that may be solicited on its behalf.This may include, but is not limited to print advertising, photographs, public service announcements, promotional materials, video or audio recordings, news reports, etc. I understand I will not be eligible for any compensation related to the production and use of my name, image, voice, appearance, or likeness in any advertising or promotional materials and other media coverage as set forth herein. r L-Ztr,�7 Aj&ZS�6� Name of Member(Please Print) /6347 Signature of Member Date Please submit all Membership Applications with payment to: Chelsea Smock, CIAVA Secretary CIAVA, P.O. Box 732, Indianapolis IN 46206 Questions? info(_ ciava.org www.CIAVA.org Application Valid Through 7/31/2017 4r\ F TV 774 D JAN 2 4 2011 CIAVABY:.............................. Central Indiana Association of Volunteer Administration P.O. Box 732 Indianapolis, IN 46206-0732 Invoice #A0000267b Date: January 24, 2017 Organization or Company: Carmel Clay Parks & Recreation 1411 E. 116th Street Carmel, IN 46032 317.573.4024 cnelsen@carmelclayparks.com Contact Person: Camille Nelsen January meeting— 1 non-member $17 Signature of Receiver Title or Office of Receiver NO Goods or Services were given to the donor for this donation Goods or Services were received by the donor: $ value JAN 2, 4 200 r CIAVABY:.............................. Central Indiana Association of Volunteer Administration P.O. Box 732 Indianapolis, IN 46206-0732 Invoice #A0000267a Date: January 24, 2017 Organization or Company: Carmel Clay Parks & Recreation 1411 E. 116th Street Carmel, IN 46032 317.573.4024 cnelsen@carmelclayparks.com Contact Person: Rachael Fleck January meeting — 1 member $12 Signature of Receiver Title or Office of Receiver NO Goods or Services were given to the donor for this donation Goods or Services were received by the donor: $ value