311767 5/30/2017 1��.c�gMF
a; ,� CITY OF CARMEL, INDIANA VENDOR: 00350628 CHECK AMOUNT: $*******825.00*
ONE CIVIC SQUARE INST OF POLICE TECHNOLOGY MGT
?Q; CARMEL, INDIANA 46032 UNIV OF NORTH FLORIDA CHECK NUMBER: 311767
12000 ALUMNI DRIVE CHECK DATE: 05/30117
Mime�o' JACKSONVILLE FL 32224-2678
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
210 4357000 100462 825.00 TRAINING
0 6 q -D O k CD - U) = 0
ƒ # wit
° 2 E < ® C C:
E q # » b k k ?
\ K o 0
0 z x r S 2
$ < k m O i m /O
m Q w m -n ¥ q
C,
\ 3 > 2 �
8 2
/ o k /
/
N) (n CD q 9
] \ m
$ % q
2 ? 2
O
< _ 2
/ |
§ § O
/ 8 w
$
2 >
0 ® E §
{ i g $ / \ f m
CD \ -,3- ; n o
-n & § � ƒ + -
E q - m /«
k o f 0) 2 k
% a CL 0 f E 7
i CD $ % / 8 ,
0 a $ 0 Q /
] o f a
§ k§ } q
ELw [ / /
I
§ C kCD ƒ §
l
0 7
y ƒ
Km § -0 -CD 0
CD m - k
CL -1# E
CDCD & 1 > /
�® 0 \ i
; k Co ° 0
8 7 o § Q ]
00) C k [
; ; m \
2 ikk k c g
CA00 D
CA 0. = %
}_ƒ CD \ D
§o & a E
§� k \ � \
§
Q -. ;uf m
° D G
n / [ j E / § i r- 0
z \ 3
] \ / C
J 2 0 c _ 0
Q 0) & R m / } \
§ 2
\ § / / \ ]
7 # CD
¥
k \ §
} 2 \ 2
2
$ § Z m
Institute of Police Technology and Management
IPTM University of North Florida
Registration Form
STUDENT INFORMATION
First Name: Steven Day Phone: 317-571-2500
Middle Initial: Student Fax Number: 317-571-2512
Last Name: Cash Student Email: scash@carmel.in.gov
Address: 3 Civic Square
Address 2:
Zip Code: 46032
Americans with Disabilities Act Program Accessibility:
City: Carmel Individuals who require reasonable accommodation in order
to participate must notify the registrar at(904)620-IPTM
State: Indiana at least five working days prior to the class.
Occupation (Rank): Patrol Officer
Employer (Agency Name): Carmel Police Department
COURSE • ' •
Course Title: Advanced Traffic Crash Investigation-On-line
Course Dates: 9/11/17- 11/29/17
Course Location:
On-line paymentFull
accompany
Course Fee: $ 825.00
Please do not make airline reservations until you receive written notification confirming that the course will run as scheduled.
PAYMENT INFORMATION
Payment must be submitted with your registration.
QX Check enclosed for: $ 825.00 Make check payable to: Institute of Police Technology and Management
F1Bill my: ❑Visa ❑MasterCard ❑American Express R Discover for $
Card #: 3- or 4-digit security code:
Name as it appears on card: Expiration Date:
Email receipt to:
CANCELLATION/REFUND POLICY
Elieu
he Cancellation Request Form found at www.iptm.org and return it to IPTM. No telephone cancellations will be accepted.
inistrative fee will be assessed to all refunds if the cancellation request is received within 14 days of the course start date.
fund,student substitutions can be made or a credit can be issued for a future course. No refunds will be given for no-shows.
PERSON'SREGISTERING • • different than • -
Registering Person's Name: Luann Mates
Registering Person's Title: Administrative Assistant Phone Number: 317-571-2530
Registering Person's Email: Imates@carmel.in.gov
Return to: Institute of Police Technology and Management/University of North Florida
12000 Alumni Drive • Jacksonville, Florida 32224-2678
Phone: (904) 620-IPTM • Fax: (904) 620-2453 • E-mail: info@iptm.org