307759 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