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315774 09/06/17
CITY OF CARMEL, INDIANA VENDOR: 00350628 ONE CIVIC SQUARE INST OF POLICE TECHNOLOGY MGT CHECK AMOUNT: S""""""595.00" CARMEL, INDIANA 46032 UNIV OF NORTH FLORIDA CHECK NUMBER: 315774 v ,? 12000 ALUMNI DRIVE CHECK DATE: 09/06/17 JACKSONVILLE FL 32224-2678 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 210 4357000 595.00 TRAINING SEMINARS n c- E « « S 7 O / 2 / \ 0 i ¥ # 2 o < o i° ^ g r- k k # ? 0 < 0 0 E 2 ? \ z � E w 2 $ < 2 f O --j C-) E O / } k # / k 0 0 00 \ / / 0 \ 2 m % 0 \ ] \ C \ � 00 $ / > k 2 ' 0 # > z O / \ \ k $ 8 z � % J , e 9: - 2 > _ % 0 ^ I ? 3 -n i g / \ § $ (D , \ s G -n o E d § U) 3 - # ¥ / - ® 0) w 0 [ n # \ f k 7 � E ] % 7 8 , % =L 2 CD o E a + o & , E / k { E { / , 0 0 � / A � § Z 3 a o / _k I \ q o f 7 l -4j m \ ( \ CD 0 # E D ) � � z CD ) \ 7 § <\ o 0 i 0) \ 2 q ƒ C o ) / D 0_ Z 9 CD 0 OCi 3 g 6/ 7� © 0 > }_ƒ m )o D & - \ m D e k $ E 2 \ ƒ m 0 / / \ j E CD c O I 7 f z \ ] i / ƒ c f 3 0 c U \ $ / § CD \ g g / @ CLR E _ -n q m § § 0 \ § ( CL > CD i § / 2 CD § . N CD @ k � ® k Institute of Police Technology and Management IPTM University of North Florida Registration Form STUDENT INFORMATION First Name: Chad Day Phone: 317-571-2500 Middle Initial: Student Fax Number: 317-571-2512 Last Name: Amos Student Email: camos@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: IN at least five working days prior to the class. Occupation (Rank): Detective Employer (Agency Name): Carmel Police Department COURSE •R • Course Title: Burglary/Robbery Investigations Course Dates: 9/25- 9/27 Altamonte Springs, Florida Full • • yment must Course Location: accompany Course Fee: $ 595.00 IL 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. ❑X Check enclosed for: $ 595.00 Make check payable to: Institute of Police Technology and Management Bill my: F]Visa [:]MasterCard [:]American Express FiDiscover for $ Card #: 3- or 4-digit security code: Name as it appears on card: Expiration Date: Email receipt to: CANCELLATION/REFUND POLICY Complete the Cancellation Request Form found at www.iptm.org and return it to IPTM. No telephone cancellations will be accepted. A 20%administrative fee will be assessed to all refunds if the cancellation request is received within 14 days of the course start date. In lieu of a refund,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 Registering Person's Name: Luann Mates Registering Person's Title: Administrative Assistant Phone Number: 317-571-2530 Registering Person's Email: (mates@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