HomeMy WebLinkAbout188375 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: 143001 Page 1 of 1
ONE CIVIC SQUARE INDIANA ASSOC OF CITIES TOWNS
CHECK AMOUNT: $300.00
CARMEL, INDIANA 46032 CONFERENCE REGISTRATION
200 S MERIDIAN ST, SUITE 340 CHECK NUMBER: 188375
INDIANAPOLIS IN 46225
CHECK DATE: 813/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4357004 300.00 IACT ANNUAL CORDRAY
1ACT Annual Conference Registration Form
Registration Deadline: September 20
Please print or type. (Register one delegate and spouse /guest per form. D,pli, It form as needed.)
a
Full Name First Time Attendee? U Yes
Itle Preferred Name for Badge _L_(a_n OU
T =1
Name
[Mij nicl pa li�/�onipanyr
City or town /State /Zip
0
Email I
Phone
Spouse /Guest Name Sp ecial Needs
Registration On/before After Enter
Deadline: September 20 9/20/10 9/20/10 Amount Pay ent Method
MasterCard U Discover
Member Municipal Offici (population greater $300 $350 Check Yvisa
than or equal to 1,000)
Member Municipal Official (Population less-than yable to IACT)
$210 $260
1,000�
Cardholder Name
Associate Member $300 $3 50
L Credit Card Number
Spouse/Guest* $185 $235
Fxpiration Date A I 3-digltVerificat !on Code
Non-mom1bor_______ $445 $495
Municipal Day (Monday Only) $185
Ci ty o r Town/ Sta te/Zl p
Sunday Golf Outing 5130 N/A
Signature of Cardhollor
*The spouse/guest registration fee is (e- TOTA A D U E S
stri c ted to those who are riot municipa of-
ficials and who have no professiona[ Pie s DAY W e Check the Zference a Events You lan,�tlend
interest at the conference. The fee in
Parl
cludes admission to all conference events, 8,Br, f A
Iome r NIDAY UpeoIn9BuslnessSessi,,= I wards Lunche TUESDAY Breakfast
the Exhibit Had, Meals and participation in F /S
the guest program.
A 7 _AUNESDAY Closing Breakfast
UESDY Lunch _;iessI.n
JESIDAY Closingilusiness ES Reception and Hari
Cancellation Policy Affiliate Group Events
Only written cancellations will be accepted. Please mail your written cancellation to IACT affiliate groups wiil hold individual meetings and events at the conference.
200 S. Meridian St., Suite 340, Indianapolis, €N 46225; fax to (317) 237-6206 or Attendees must be registered for the conference in order to attend affiliate events.
send to theinzroat)@citiesandtowns.org. Written cancellations received on or before Additional meeting and event information for affiliate group Members may be
September 27, will be refunded less a $40 processing fee, [ACT is not responsible for mailed out separately.
hotel reservations or cancellations.
I R 1111 J:�V r
I I A VIJ
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EDNI
2 ;A
Z �Ifl, I
Foursome Optio arm I ^'ptis To 11111
lr,7�7 im
]ACT can place you in afo rsonne or u can request to a
ualF it P
illIH1 f I Y
le, please l ist your desired
with certain individuals, It
playing partners:
V
day u-0 J
If 0i ton
heV6: Sycamdre:Hills Golf Club (11836 Covington Road, Fort Wayne, 46814)
Whdni Wober 9:30 a. M. --2:30 p.m.,
co $130 per person
Prior to the kick off of Sunday evening events, take a swing in this year's golf outing. Participants will play Fort Wayne's Sycamore Hills Golf Club, a
stunning Nicklaus-designed course. Please note the golf feeds in addition to your conference registration fee. Tee -time is 9:30 a.m. Players must
provide own transportation. Lunch provided.
U YES I wouldlike to play. Don't forget to enter the price for golf in the registration for- above if you -..Id like to play.
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
p 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
�qu Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
I 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
VOUCHER NO. WARRANT NO.
ALLOWED 20
l"AfT
U I IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
7&D 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
1
6 r 2 0
u re
9
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund