186823 06/23/2010 CITY OF CARMEL, INDIANA VENDOR: 359978 Page 1 of 1
ONE CIVIC SQUARE GOLF COURSE SUPER. ASSOC OF AMEERRI
s 0 CHCK AMOUNT: $370.00
j, CARMEL, INDIANA 46032 PO BOX 219004
KANSAS CITY MO 64121 -9004 CHECK NUMBER: 186823
CHECK DATE: 6/23/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4355300 183763 370.00 ORGANIZATION MEMBER
GCS A OFF C
REMIT TO: 1 6482
1421 Research Park Dr, Lawrence, KS 66049 -3859
Call: (800) 472 -7878 Fax: (785) 832 -3643
DUDES INVOICE
FINAL NOTICE RENEW ON -LINE TODAY AT WWW.GCSAA.ORG
183763
Your preferred mailing address: 7/1/2010 6/30/2011
164825 A
Robert D. Higgins Other Address: 024887
16133 Hymera Gm
Westfield, IN 46074 -8418 Brookshire Golf Course
UNITED STATES 12120 Brookshire Pkwy
Carmel, IN 46033 -3314
UNITED STATES
Your Class A Renewal, Cycle is: 07/01/2003.- 04/05/2011: Would you "like to continue to receive YEg 0jp'
Golf Course Management magazine?
CHAPTER MEMBERSHIP Use the spaces below to update your home and /or golf course information.
NEW Home Mailing Address: (Provide ONLY if changed address.)
Indiana GC5A, Michiana GCSA
Street or P.O. Box (1)
Vote is with: None 'Street or. P'O. Box (2)
City, State, Zip
IF YOU WOULD LIKE TO CHANGE YOUR VOTE,
PLEASE CONTACT MEMBER SOLUTIONS 1- 800 Country
472 -7878 FOR AN AFFIDAVIT.
Phone Fax
Current E -mail Information: If possible, please provide a mailing address that includes a street address. Fed Ex will
not deliver to a PO Box.
(GC5AA does not rent or sell email addresses.) NEW Golf Course Information:
(Provide ONLY if you have changed positions.)
Date started
bhiggins @carmel.in.gov
Golf Course Name
Street or RO. Box (1)
Please update below, if needed: Street or P.O. Box (2)
City, State, Zip
Preferred E- mail "(To be used for ail, GCSAA Country
correspondence)
PUBLISH E -mail address in the ]YES ❑NO Fax
Membership Directory? Phone
GOLF COURSEMAMAGEME/VT GIFT SUBSCRIPTION(S)
You may, as a professional courtesy, send a maximum of two Golf Course Management(GCM) subscriptions to your club president, green chairman,
employer or other appropriate party.
To send complimentary subscriptions to a new /or different person, go to htti2r//www.qcsap.ora/profilelaoftsub-aspx
0' 113E
164825 A Robert D. Higgins 183763 7/1/2010 6/30/2011 $320.00
I
To continually improve membership programs and resources, please provide the following information. Your participation will enable your association to build
the most comprehensive database in the golf course management industry.
1. What is your annual maintenance budget? (circle one)
a. Less than $250,000 d. $750,000 $999,999 g. $1,500,000 and over
0 250,000 $499,999 e. $1,000,000 $1,249,999
c. $500,000 $749,999 f. $1,250,000 $1,499,999
2. What percentage of your annual maintenance budget is spent on the following categories? If necessary, provide an estimate.
(Total must add up to 100
a. (a Labor (include all payroll expenses: salaries, hourly wages and labor contracts)
b. C? Water (include all water costs)
C. 9 0 Other (include all remaining items in your maintenance budget)
3. How many golf holes are maintained through your annual maintenance. budget? Enter number of holes Z8
4. How much do you spend annually on maintenance equipment purchases and leases? 6,0 1 1 00 j2 /i
5. What is your predominant turf -type on: tees fairways R ,o Q greens
6. What percentage of your maintenance fleet is owned vs, leased? Own Leas 9Q (Total must add up to 100
Il;nvironmgPtaf
What is your gender? Male Female Inettilute for Golf
Which of the following best describes your ethnicity?
White Black/African American Your $50 voluntary contribution is advancing the
Hispanic /Latino Asian profession by.
Multiracial American Indian /Native American /Alaskan Native enhancing environmental,
recreadonal
-and economic aspects of golf courses.
Birthdate I (mm /dd /yyyy) Are you a citizen of the United States my ❑N
For more information regarding the life insurance benefit, go to www.gcsaa.org and search for Affinity
Programs. visit www.eifg.org for more information.
GCSAA Bylaws require that the following information be confirmed and returned with your annual dues remittance.
Your current job title or position is: Check the box if your job title or position has changed and please use the
enclosed GCSAA Reclassification Form to update your information.
Golf Course Superintendent
Title II hereby certify that my information is correct.
Semi- private 18 n Member's Signature (Ir Date
Facility Type Holes
Please Make A Copy For Tax Purposes: GCSAA dues are not deductible as a charitable contribution for federal income tax purposes, but may be deductible as
an ordinary and necessary business expense. GCSAA estimates that 8% of your membership dues are not deductible as this portion will be used for advocating positions on
government issues, as well as for the payment of dues terns life insurance for all members excluding students, affiliate companies, technical assistance network, International
Superintendent Member (ISM) and non -U.S. citizens.
The Environmental Institute for Golf is exempt from taxation under Code Section 501(c)(3) of the Internal Revenue Service. Your voluntary gift is deductible as a charitable
contribution for federal tax purposes to the extent provided by law.
METHOD OF PAYMENT
�:Membershtp Dues: $320.00
❑Check Enclosed ❑American Express ❑MasterCard Visa
Prepaid Amount! $0.00
U.S. Funds Only (U.5. dollars drawn on U.S. bank) TOTAC DUES OWED $320.00
'_....w _M.:.....:..._:.
Credit Ca m Volunta Contnbu_d to The Environmental Insttwte for Golfe 50.00
/20 TOTAL 2 DUES and CONTRIBUTION $370.00
Expiration Date Card Holder Name (please print)
Join or renew the Golden Tee.Club by contributing an additional
Signature $5Qheire. e�
Make checks payable to: GCSAA ter. TOTAL AMOUNT ENCLOSED' 3) O
REMIT TO: 1421 Research Park Dr, Lawrence, KS 66049 -3859 Call: (800) 472 -7878 Fax: (785) 832 -3643
REN
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164825 A Robert D. Higgins 183763 7/1/2010 6/30/2011 $320.00
Membership Number:
GCSAA PROVIDES FREE LIFE INSURANCE WITH YO
1 MNMERSHIP
Al'l. membe.rs (excluding non -U.S. citizens, and the'following member classifications: Student,
Affiliate Company, Technical Assistance Network, and International Superintendent Member),
are automatically enrolled into the dues term.life insurance :group policy.. This benefit is at no
additional cost to you GCSAA pays for this benefit.
?For more information go to http: /www.gcsaa.org/ Join/ MemberBenefifs /irisurarice.aspx
As a part of your membership your beneficiary will receive:
Dues Term Life and AD &D Insurance:
Age Life Insurance Benefit AD &D Benefit
65 $10,000 $10,000
66 -69. $5;000, $5;000
70 .�$i.;00
_$1,000..4.:_.
We strongly encourage our members to update their beneficiary information on.an annual
basis to ensure their information is current. If a beneficiary Js.not named,'state law will
govern the distribution of funds. Please take a moment and update your information
in the box below. Please note: Updates to beneficiary information will automatically'replace any prior
beneficiary designation(s). Surviving beneficiaries will be paid equally unless otherwise indicated.
Annual Beneficiary Update
Da
to of Birth l Reladonsh to Member
Primary: [,�.0 t it g,
Contingent: 44 e,, L fit ,
You rnust sign and date below in order to niake your designation(s) official:
Member Narne.(Printed):
1 r
Signature Date: l 41 to
Yes, h am a U.S. Citizen. (MM /DDNYY�
Member -Date of Birth:
(MM /DD /YYYY)
When complete, please either return this form along with your renewal form, or fax this form to
our- Customer Solutions Group, (785) 832 3643. Upon receipt, we will update this information
accordingly. Questions about this benefit?. Contact Customer Solutions'at (800) 472 -7878.
Thank, you for helping us keep your information up -to- date?
VOUCHER NO. WARRANT NO.
ALLOWED 20
G SAA
S( L /Yi( I -CCU IN SUM OF
l'
1421 Research Park Dr,
Lawrence, KS 66049 3859
$370.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Me mbers
1207 183763 43- 553.00 $370.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Tuesday, June 15, 2010
Director, Brooksh a Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
07101/10 183763 Dues $370.00
1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20
Clerk- Treasurer