HomeMy WebLinkAbout315488 8/30/2017 �`' ���" CITY OF CARMEL, INDIANA VENDOR: 00352482
�: CHECK AMOUNT: $......"600.00*
ONE CIVIC SQUARE IMPACT
rte; CARMEL, INDIANA 46032 125 W MARKET STREET STE 240 CHECK NUMBER: 315488
�. INDIANAPOLIS IN 46204-2882 CHECK DATE: 08/30/17
/spry-�'.
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4355300 LAMB 200.00 ORGANIZATION & MEMBER
1201 4355300 SPELBRING 200.00 ORGANIZATION & MEMBER
1201 4355300 WOLFGANG 200.00 ORGANIZATION & MEMBER
«
00 z > Cil
> j k
ƒ § § § 2 2 0
n , n
0 -0
> D I ® # 2
0 o o 0 O ;o X
O E
\ \ \ / 0
% L� � v g 2 $ #
E 4 o ƒ q § O &
a 00
( ƒ e # q 7 m
[ CY 2 k m -0 7
E W E \ ®
) / k q / m k
/ (AX
CA 54 S4 CDk k
8 8 8 ® >
& _�
3 O
§ z
> -nO
t # # # § 3
E $ § $ = m (
( 8 8 8
6
) a a 9 r,
\ =rCD k 2 ? §
% E g ¢ E J § K
¥ CD , e ? ; -n o
c 0 3 ƒ § -
r / k / § 2 ®
% I 2
7 k
cr > m _ E —
k co k ! ƒ § \
0 J a m N m
o %
m E O E
a ( a =
PQ
/ 2 i
7 rr
C A
/ ƒ §
cr
;
« 7
\/ \ \ \ } j \ } CD
CDE
\ ECD D D
2e E 2 R � 7
2 � 4 /§ , kK)cD z } \
A k / k $\ S 7 L 2 q JC o
; J % _ , 2 . # $ f Z
%kcr 3
m
� � J
° 0 >
$ § § / ( IE0 D
n n a & a E
j\ 00 i ; q t D
§ \ ) / \ M
n / % \ a j U / r
$ ƒ § 0 G ƒ % ] / CD
( C
m 3 7 a , 0
0) rrcr
° CD o \ \ \
\ a _
k o
CD CL ]
CD \ z
A CL > \ \ d
- - - IID ° 2
o .
CD z
<
8 8 E \
TWO EASY WAYS TO REGISTER!
CONFERENCE
REGISTRATION
By mail:
IMPACT
125 W.Market St.Suite 100
Indianapolis,IN 46204
By fax:
(317)237-6206
HOTEL RESERVATIONS
h DoubleTree by Hilton
Lawrenceburg,Indiana
51 Walnut Street
Lawrenceburg,IN 47025
Hotel Rate:$114
Aim Room Block
Book by phone:(812)539-8888
Deadline for hotel registration is:
September 6,2017
Deadline for conference registration
is:September 13,2017
2017 IMPACT ANNUAL CONFERENCE REGISTRATION FORM
Your Information Method of Payment
Name t �(�yy`� (Circle One) Check MasterCard Visa Discover American Express
City/Company (i (r%j O� n L2 Check Number
Title Card Number
Address C I I C. S ,N-f2L Expiration Date
City/Town V-Y\ L.Z Verification Code
State Name of Cardholder
Zip i j L, Cy:5 J� Authorized Signature
Phone 3 1,7 57/ )�!7/ Billing Address(if different from above)
Email 1& h ecarMe! . I,'• G City
Email Ashley Spurgeon at aspurgeon@aimindiana.org with dietary or allergy concerns. State
Zip
IMPAC
Registration Fee for 2017 IMPACT Annual Conference
.Id$200-Full 2017 IMPACT Annual Conference(IMPACT Member)
❑$250-Full 2017 IMPACT Annual Conference(Non-IMPACT Member)
❑$150-One Day Rate(Designate a Day:Sep.20,21,or 22):
❑I would be interested in attending an after-hours event on Sep.20 at no extra fee.
TWO EASY WAYS TO REGISTER!
CONFERENCE
REGISTRATION
By mail:
IMPACT
125 W.Market St.Suite 100
Indianapolis,IN 46204
By fax:
(317)237-6206
HOTEL RESERVATIONS
DoubleTree by Hilton
Lawrenceburg,Indiana
51 Walnut Street
Lawrenceburg,IN 47025
Hotel Rate:$114
Aim Room Block
Book by phone:(812)539-8888
Deadline for hotel registration is:
September 6,2017
Deadline for conference registration
is:September 13,2017
2017 IMPACT ANNUAL CONFERENCE REGISTRATION FORM
Your Information Method of Payment
Name s S 7 lei R 1 ti (Circle One) Check MasterCard Visa Discover American Express
City/Company L' �� 0 ,Y1 C-Z Check Number
Title D l (!-LT R A TC<. Card Number
Address C// a/I c S c,; 2C- Expiration Date
City/Town CIA Z Verification Code
State T:k) Name of Cardholder
Zip G j Authorized Signature
Phone `3 -7 _5. 5� Billing Address(if different from above)
Email TP 5PL1.r3kI ti ' C to&Z. //U, G L)4,1 City
Email Ashley Spurgeon at aspurgeon@aimindiana.org with dietary or allergy concerns. State
Zip
rr
pa�j; Registration Fee for 2017 IMPACT Annual Conference
*$200-Full 2017 IMPACT Annual Conference(IMPACT Member)
O$250-Full 2017 IMPACT Annual Conference(Non-IMPACT Member)
❑$150-One Day Rate(Designate a Day:Sep.20,21,or 22):
■1 would be interested in attending an after-hours event on Sep.20 at no extra fee.
TWO EASY WAYS TO REGISTER!
CONFERENCE
REGISTRATION
By mail:
IMPACT
125 W.Market St.Suite 100
Indianapolis,IN 46204
By fax:
(317)237-6206
HOTEL RESERVATIONS
DoubleTree by Hilton
Lawrenceburg,Indiana
51 Walnut Street
Lawrenceburg,IN 47025
Hotel Rate:$114
Aim Room Block
Book by phone:(812)539-8888
Deadline for hotel registration is:
September 6,2017
Deadline for conference registration
is:September 13,2017
2017 IMPACT ANNUAL CONFERENCE REGISTRATION FORM
Your Information Method of Payment
Name S U L (,u is I F G A-ti-'G (Circle One) Check MasterCard Visa Discover American Express
City/Company C i f- b ( i2i�) L Z Check Number
Title Lw C,y L LCL F I f C � Card Number
Address ) I v C SCS v Y�(Z-t Expiration Date
City/Town Zi-1 �Z Verification Code
State -170 Name of Cardholder
Zip L-f u o '3 U Authorized Signature
Phone3 I sT_ Billing Address(if different from above)
Email Sial r�r;FYn;<��CR{1ln�Z. J �Oi� City
Email Ashley Spurgeon at aspurgeon@aimindiana.org with dietary or allergy concerns. State
rr 11 Zip
' M Registration Fee for 2017 IMPACT Annual Conference
S$200-Full 2017 IMPACT Annual Conference(IMPACT Member)
E3$250-Full 2017 IMPACT Annual Conference(Non-IMPACT Member)
L3$150-One Day Rate(Designate a Day:Sep.20,21,or 22):
I would be interested in attending an after-hours event on Sep.20 at no extra fee.