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192844 12/15/2010 CITY OF CARMEL, INDIANA VENDOR: 00351829 Page 1 of 1 ONE CIVIC SQUARE INDIANA ARBORIST ASSOC CHECK AMOUNT: $380.00 CARMEL, INDIANA 46032 ATTN: RITA MCKENZIE 195 MARSTELLER ST CHECK NUMBER: 192844 WEST LAFAYETTE IN 46907 -2033 CHECK DATE: 12/1512010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1192 4343002 380.00 EXTERNAL TRAINING TRA 2011 Indiana Arborist Association Annual Conference REGISTRATION FORM PERSONAL INFORMATION (Please print) Last Name: First Name: Middle Initial Preferred Name on Badge: T Please send membership information to (check one): Home 11 Business Daytime Phone No.: Fax No.: 1 31 1 --)993 Home Address: Business Address: City: State: Zip: City i Zip: e Employer: 1 Email: 7 AJ d"", 'A'a MEMBERSHIP DUES On or After If you register to become a member of IAA on this registration form, Before TOTAL you will receive the IAA conference member rate 12/18/10 12/18/10 2011 IAA Membership Dues 1 $40 I WORKSHOP FEES Arborist Certification Review Session $45 11 $45 Purdue Pesticide Core Review Ft Test Contact Indiana State Chemist Office FULL CONFERENCE All Meals Included IAA Member Rate $250 $300 Non-Member Rate $300 $350 Student Rate (full-time student with picture ID) $45 I $45 SINGLE DAY Please check which day Tuesday 0 Wednesday Thursday $150 $150 SPOUSE REGISTRATION 8t TRADE SHOW ASSISTANT $125 $125 Wednesday Et Thursday meals only TOTAL A)lq UJ METHOD OF PAYMENT Credit Cards are now accepted online. Visit www.indiana-arborist.org Check Enclosed, payable to Indiana Arborist Association Mail Registration Payment to: Lindsey Purcell, 195 Marsteller St., FORS 110, West Lafayette, IN 47907-2033 Purchase Order Number Email to [anurce[@Purdue.edu or fax to 765-807-5166 Purchase Order Mailing Address: Contact Name: Contact Phone No.: 201 Indiana Arborist Association Annual Conference January 18 -20, 2011 EXHIBITOR Et SPONSORSHIP REGISTRATION FORM SPONSOR /EXHIBITOR INFORMATION (Please print) Company Name: Contact Name: Daytime Phone No.: t Fax No.: Add ress Email: City: State; 1 Zip EXHIBITOR SET-UP INFORMATION (Trade Show Starts Tuesday at 12:00pm) Large Equipment Set-Up: Monday, January 17 Noon to 6:00pm Ft Tuesday, January 18 8am to Noon Booth Set-Up: Tuesday, January 18 8am to Noon Booth Tear-Down: Thursday, January 20 1:30prn to 5pm SPONSORSHIP INFORMATION TOTAL CONFERENCE SPONSORSHIP (please check the appropriate box) I Tulip $2,500 Sycamore $1,000 Oak $500 Walnut $200 Maple $100 WEDNESDAY NIGHT SPONSORSHIP. (please check the appropriate box) $30o szoo $loo $50 EXHIBITOR BOOTH INFORMATION On or After j Before Each Booth receives 1 Full Conference Registration and 1 IAA Membership 12/18109 12/18/09 Number of Booths Booth is 10' by 8' wide and includes 2 chairs and carpet $350 $400 (please circle) 6 foot table or 8 foot table Electricity $30 $30 TOTAL NEW EXHIBITOR POLICY Please note that prior to the conference, payment must be received in full It a Certificate of Insurance must be received Listing the IAA as a co-insured SILENT AUCTION INFORMATION I will( be bringing for the auction, silent auction or raffle. ADDITIONAL VENDOR ATTENDEES Each Booth receives 1 Full Conference Registration and I IAA Membership Additional Vendor Attendees must fill out the attached Conference Registration Form METHOD OF PAYMENT uW Mail Registration Payment to: Lindsey Purcell, 195 Marsteller St., FORS 110, West Lafayette, IN 47907-2033 For Credit Card or Purchase Order only: Email to lapurcefturclue&du or fax to 765-807-5166 Check Enclosed, payable to Indiana Arborist Association Credit Card: Please charge my (circle one) Visa Am Ex MasterCard Card Number: Expiration Date: Name as it appears on card: Signature: Payment Address (required for processing): 2011 Indiana Arborist Association Annual Conference PERSONAL INFORMATION (Please print)` Last Z i� e: Fir Name: Middle Initial: In &J t.��_ M. Preferred Name on Badge: Please send membership information to (check one): Home Business Daytime Phone No.: Fax No.: 3 -57) -a '97R 3i 5 NZ( Home Address: Business Address: O r'-p Cl v1G S� City: State: .Zip: City S�a� Zip: q(0 i7 Employer: Email: n register to become ME M B ERSHIP IAA on his registration form Before 1 TOTAL g 4 After If you re You will receive.the IAA conference :member rate i 2/18/10 .2/18/10 2011 IAA Membership Dues $40 WORKSHOP FEES Arborist Certification Review Session $45 $45 Purdue Pesticide Core Review Ft Test Contact Indiana State Chemist Office FULL CONFERENCE `All Meats Included IAA Member Rate $250 $300 Non- Member Rate $300 $350 Student Rate (fult -time student with picture ID) $45 $45 SINGLE DAY Please check which day Tuesday Wednesday Thursday $150 $150 15� SPOUSE REGISTRATIOW& TRADE SHOW ASSISTANT $125 $425 :Wednesday Thursday meals only TOTAL 190 METHOD OF PAYMENT Credit Cards are now accepted online. Visit www. indiana-arborist. ore Check Enclosed, payable to Indiana Arborist Association Mail Registration Payment to: Lindsey Purcell, 195 Marsteller St., FORS 110, West Lafayette, IN 47907 -2033 Purchase Order Number Email to lapurcet@purdue.edu or fax to 765 -807 -5166 Purchase Order Mailing Address: Contact Name: Contact Phone Flo.: 2011 Indiana Arborist Association Annual Conference January 18 -20, 2011 EXHIBITOR €t SPONSORSHIP REGISTRATION FORM SPONSOR /EXHIBITOR INFORMATION (Please print) Company Name: Contact Name: Daytime Phone No.: Fax No.: Address: Email: City: State: Zip EXHIBITOR SET -UP INFORMATION Trade Show Starts Tuesday at 12:00pm) Large Equipment Set -Up: Monday, January 17 Noon to 6:00pm Et Tuesday, January 18 8am to Noon Booth Set -Up: Tuesday, January 18 8am to Noon Booth Tear -Down: Thursday, January 20 1:30pm to 5pm SPONSORSHIP INFORMATION TOTAL CONFERENCE SPONSORSHIP (please check the appropriate box) Tulip $2,500 Sycamore $1,000 Oak $500 Walnut $200 Maple $100 WEDNESDAY NIGHT SPONSORSHIP (please check the appropriate box) $300 $200 $100 $50 On or: EXHIBITOR BOOTH INFORMATION After Before Each Booth receives 1 Full Conference, Registration and 1.IAA Membership 12/18/09 12/18/09 Number of Booths Booth is 10' by 8' wide and includes 2 chairs and carpet $350 $400 (please circte) 6 foot table or 8 foot table Electricity $30 $30 TOTAL NEW EXHIBITOR POLICY Please note that prior to the conference, payment must be received in full Et a Certificate of Insurance must be received listing the IAA as a co- insured SILENT AUCTION INFORMATION I will be bringin for the auction, silent auction or raffle. ADDITIONAL VENDOR ATTENDEES Each Booth.receives 1 Futl.Conference Registration and.1 -IAA Membership Additional Vendor Attendees must fill out the attached Conference Registration Form METHOD OF PAYMENT Mail Registration Payment to: Lindsey Purcell 195 Marsteller St.,`FORS 110; West Lafayette; IN 47907 -2033 For Credit Card or Purchase Order only: Email to lapurcelCpurdue.edu or fax to 765 -807 -5166 Check Enclosed, payable to Indiana Arborist Association Credit Card: Please charge my (circ €e one) Visa AmEx MasterCard Card Number: Expiration Date: Name as it appears on card: Signature: Payment Address (required for processing): VOUCHER NO. WARRANT NO. ALLOWED 20 Indiana Arborist Association IN SUM OF 195 Marsteller Street West Lafayette, IN 47907 -2033 $380.00 ON ACCOUNT OF APPROPRIATION FOR Carmel DOCS Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1192 43- 430.02 $380.00 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 Monday [?ee 6qiberp, 2010 l &6 ctor, DOC 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)) 12/09/10 Conf. Daren and Nichole $380.00 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