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Home My WebLink About188857 08/18/2010 a CITY OF CARMEL, INDIANA VENDOR: 143250 Page 1 of 1 ONE CIVIC SQUARE INAFSM i CHECK AMOUNT: $380.00 CARMEL, INDIANA 46032 115 W WASHINGTON ST, SUITE 1368 S C/O CHRISTOPHER BURKE CHECK NUMBER: 188857 INDIANAPOLIS IN 46204 CHECK DATE: 8/18/2010 DEPARTMENT ACCO P NUM BER INVOICE NUMBER AMOUNT DESCRIPTION 2200 4357004 380.00 EXTERNAL INSTRUCT FEE cot�\ood4,�n and Sro��kdr o INAFSM 2010 ANNUAL CONFERENCE O REGISTRATION MEMBERSHIP APPLICATION September 15th -17th 1 AFS M n Brown County State Park, Nashville, Indiana Send your registration to: By Mail: INAFSM Attn: Unique Dahl 115 W. Washington Street, Suite 1368 South Indianapolis, Indiana 46204 By Fax: (317) 632 -3306 MAKE CHECKS PAYABLE TO: INAFSM Website Address: www.inafsm.net REGISTRATION FEES (No registrations accepted after September 3, 2010) Early Registration A. Member (Early until July 2nd) 140.00 B. Non- Member (Early until July 2nd) 180.00 C. Student (Full -Tim 30.00 Regular Registration D. Member (Regular until August 6 170.00 E. Non Member (Regular until Aug. 6` 210.00 1 70- U� Late Registration F. Member (Late until Sept 3 200.00 G. Non- Member (Late until Sept 3 240.00 Guest Meal Package I H. Guest Meal Package $100.00 (Total of 6 Meals) (Package includes: continental breakfast on Thursday and Friday, lunch on Wednesday, Thursday, and dinner on Wednesday, and Thursday.) Please provide Guest Name for Name Badge Sa NN /710MA- 5 INSERT THE APPLICABLE FEES AND ADD COLUMNS FOR TOTAL REGISTRATION FEES If you would like to become an INAFSM member please visit www.inafsm.net to download membership form. TOTAL AMOUNT OF PAYMENT 4 t 7 Name: U �/u A-5 TOTAL (i.e., PE, CFM etc.) C P, G EMAIL: e l °�'1A'S a CC-rrmc in :2 0 Phone: ?/7) 2'I `tl (Em ail is the primary form of contact for INAFSM) Fax: j�j 7� Co. Name: .i 0� Ll 1 Company Address: One tu 0 1 )P're" City /State /Zip: �jAr 7b O 3 Questions? Contact Unique Dahl at (317) 536 -6721, or admin@inafsm.net CANCELLATION POLICY If your plans change and you cannot attend, written notice must be provided to the INAFSM office. Avoid the cancellation service charge by sending a substitute from your organization, or choose to credit your paid registration fee to next year's conference! Otherwise, cancellations postmarked up to August 20 2010 will be assessed a $40 service charge No refunds will be made after September 3, 2010. All registrations received by INAFSM are subject to the cancellation policy, regardless of payment status. "No Shows" will be charged the full amount. No refunds can be made for unused portions of the conference. PAYMENT METHOD: All fees payable by check or purchase order only. INAFSM Federal ID# is 35- 2010247 \oo ..kain and Sror� Co �'r INAFSM s 2010 ANNUAL CONFERENCE REGISTRATION &MEMBERSHIP APPLICATION September 15th -17th C 1 NAPS 1\A n Brown County State Park, Nashville, Indiana Send your registration to: By Mail: INAFSM Attn: Unique Dahl 115 W. Washington Street, Suite 1368 South Indianapolis, Indiana 46204 By Fax: (317) 632 -3306 MAKE CHECKS PAYABLE TO: INAFSM Website Address: www.inafsm.net REGISTRATION FEES (No registrations accepted after September 3, 2010) Early Registration A. Member (Early until July 2nd) 140.00 B. Non- Member (Early until July 2nd) 180.00 C. Student (Full -Time) 30.00 Regular Registration F= D. Member (Regular until August 6` 170.00 f_:�E. Non- Member (Regular until Aug. 6 210.00 $2-10 Late Registration C1 F. Member (Late until Sept 3 200.00 G. Non- Member (Late until Sept 3 240.00 Guest Meal Package CO H. Guest Meal Package $100.00 (Total of 6 Meals) (Package includes: continental breakfast on Thursday and Friday, lunch on Wednesday, Thursday, and dinner on Wednesday, and Thursday.) Please provide Guest Name for Na Badge K=J &T 14 N06 SON INSERT THE APPLICABLE FEES AND ADD COLUMNS FOR TOTAL REGISTRATION FEES If you would like to become an INAFSM member please visit www.inafsm.net to download membership form. TOTAL AMOUNT OF PAYMENT 0 Name: L) T A`� �E/2 5 0 Credentials (i.e., PE, CFM etc. EMAIL: ka.,^ de-r Son, t: Ira ooy Phone: (,3/7) _5;� 7,t 2 S d (Email is the primary form of contract for INAFSM) Fax: (3) Co. Name: �!"1 d� CGc��'�c I Company Address: OA �iyi' C- ✓me- City /State /Zip: 1�4" yb O 32— Questions? Contact Unique Dahl at (317) 536 -6721, or admin @inafsm.net CANCELLATION POLICY If your plans change and you cannot attend, written notice must be provided to the INAFSM office. Avoid the cancellation service charge by sending a substitute from your organization, or choose to credit your paid registration fee to next year's conference! Otherwise, cancellations postmarked up to August 20 2010 will be assessed a $40 service charge No refunds will be made after September 3, 2010. All registrations received by INAFSM are subject to the cancellation policy, regardless of payment status. "No Shows" will be charged the full amount. No refunds can be made for unused portions of the conference. PAYMENT METHOD: All fees payable by check or purchase order only. INAFSM Federal ID# is 35- 2010247 Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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 INAFSM Purchase Order No. 115 W. Washington Street, Suite 1368 South Terms Indianapolis, IN 46204 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) n/a INAFSM Conference John Thomas $170.00 Kurt Anderson 210.00 Total $380.00 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 VOUCHER NO. WARRANT NO. INAFSM ALLOWED 20 c..._ I of IN SUM OF Indianapolis, IN 46204 $380.00 ON ACCOUNT OF APPROPRIATION FOR Department of Engineering Board Members Po# or INVOICE NO. ACCT #fTITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or n/a n/a 2200- 4357004 $380.00 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 20 Signature Cost distribution ledger classification if Title claim paid motor vehicle highway fund