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Home My WebLink About192882 12/15/2010 CITY OF CARMEL, INDIANA VENDOR: 00351245 Page 1 of 1 ONE CIVIC SQUARE N L C MEETING SERVICE CHECK AMOUNT: $355.00 tic �tr CARMEL, INDIANA 46032 C/O J SPARGO ASSOC, INC •4:,, 11212 WAPLES ROAD SUITE 104 CHECK NUMBER: 192882 FAIRFAX VA 22030 CHECK DATE: 12/15/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1701 4357004 355.00 EXTERNAL INSTRUCT FEE NLC Congressional Cities Conference Registration and Housing form March 12th 16th, 2011 The Marriott Wardman Park Hotel, Washington, D.C. For Faster Registration and Housing Reservation, Register QnGno at httpJlwww,nlc.org Hotel ations: You must be registered for the Conference to reserve a hotel room. To guarantee No housing or registration will be processed without accompanying payment in fullll. your r hotels require one night's deposit plus 14.5% tax (subject to change), 30 days prior to Are you newly elected official? Size of city? w your his is required even if you plan to arrive before 6:00 p.m. If accommodations are not guara0 days in advance, the reservation w ll be cancelled. Name J Gender t ase make my hotel reservation as indicated below, Ti11e CG e- t b r-- L] I do not require hotel accommodations at any of the hotels listed below. L] Although I am providing information for a standard room for now please contact me CitylOrganization regarding suite information. Mailing A lJ Room Dates: Arrival Date: Il Departure Qate:l� 1! City r -�-1�t State Z Zip d "'777 Phone 7 Fax 7 S7( cP U Room Type: LJ Single, 1 persoNl bed LJ Quad, 4 people/2 beds J f r Double, 2 peoplell bed U Email CG('dfr r '�r i R q�d/ LJ Double/Double, 2 peoplel2 beds L] Registrant's Email 1 r h LJ Triple, 3 people/2 beds Room types cannot be guaranteed but Hotels will attempt to accommodate all requests. Youth Delegate" (Name) Age Special Conference Rates Sharing My Room With (for Hotel Check In Purposes): SG Spouse /Guest (non refundable) 50 5 First -Time Attendee $350 Special Housing Request (e.g., wheelchair accessible rooms, etc.): 7 Youth Delegate (15 -18) $100 If you have special housing or transportation needs, please contact NLC Meeting Services a1888.319- B Youth Chaperone (not applicable to elected officials) $100 3864 or 703. 449.6418 22 Students $125 41 i Y' Hotel Choices: Indicate your first-choice hotel with the number "1 Number the other hotels in order of Registration Fees: Advance On -Site @COC" preference. The Marriott Wardman Park Hotel is the headquarters hotel. Valid Until 3/11/11 Valid Starting 3/12111 Valid until 1/ y Smoking NLC Rate Breakfast 1 NLC Member City $420 $520 $35� rd Hotel Property SinglatDoubleflripf0uad Included 2 Associate Member $420 $520 $355 Marion Wardman Park No $2421$242312624282 No 3 SML Member City $540 $640 $355 Omni Shoreham No $2381$238 No 4 Nom Member /Other $645 $745 $475 On -site rate includes 100.00 processing fee. To receive advance rate, mailed or faxed registrations must be postmarked by March fit 2011. Visit www.nlc.ora and register online to ensure you meet the March deadline. Reg' Fee Payment Information 'Must include Congress of Cities registration ID number to qualify. Charge my REGISTRATION FEES to VISA, MasterCard or Ani listed below Check for REGISTRATION FEES made payable to National League of Cities Registration for Leadership Training Institute Seminars (March. 12 13, 2011) L] Purchase Order for REGISTRATION FEES -copy must be enclosed payment must be received To REGISTER, codes and fees are listed beside the Leadership Training Institute on the website. You by February 18, 2011- must be registered for the conference in order to attend. You may not select a Full Day LD and a Half- Hotel Deposit Payment Information (you must check one): Day CD on the same day. LJ Charge my HOTEL DEPOSIT to the credit card listed below. All major credit cards Wth expiration Saturday, March 12- Full -Day Seminar Code: $180 date of 03111 or later are accepted by the NLC official hotels. Saturday, March 12- Morning Seminar Code: $120 L] Check for HOTEL DEPOSIT. I understand check deposits for hotel room guarantee is payable to the Saturday, March 12- Afternoon Seminar Code: $120 hotel stated on the NLC confirmation and must be mailed after January 24, 2011 but before Sunday, March 13 -Full -Day Seminar Code' $180 February 18, 2011 and are subject to approval. Please include your 6 -digit REG ID 4 indicated on the NLC Meeting services confirmation. Sunday, March 13- Morning Seminar Code: $120 Sunday, March 13 Afternoon Seminar Code: $120 Credit Card Authorization: NLC Registration and Housing,Services is authorized to use the card below LTI Leadership Luncheon Code. $40 to pay all applicable registration fees and guarantee my hotel reservation, I understand that one night's room charge will be forfeited if I fail to show up for my assigned housing on the confirmed arrival date 2011 Constituency Group Special Event Fees unless I have canceled my reservation with the hotel at least 72 hours in advance. I understand that if I do Any NLC registered delegate may attend by paying the fees below. Visit the website for more information not show at the hotel on my confirmed arrival date, my reservation All not be reinstated for the on constituency groups. remainder of the stay unless I instruct the hotel to reinstate my reservation. Reinstated reservations are Asian Pacific American Municipal Officials subject to hotel's availability. Further, I agree to the stated Registration Cancellation policy and I APAMO Reception Al $40 understand upon cancelling my registration I will accrue a $75.00 non refundable processing fee. Gay, Lesbian, Bisexual and Transgender Local Officials VisalMasterCardlAmEx Number Exp. Dale_ GLBTLO Reception G1 $40 Card Holder Name Hispanic Elected Local OlFdais HELD Reception H1 $45 Card Holder Signature National Black Caucus of Local Elected Officials NBC -LEO Evening Event N1 $99 Additional Credit Card Authorization: For hotel deposit only if different than the credit card number Women in Municipal Government listed above. (Expiration date must be 3111 or later, per hotel requirement.) WIMG "A Capital Feast" Luncheon W1 $40 Credit Card Number Exp. Date_ Card Holder Name Celebrate Diversity Breakfast $38 Card Holder Signature TOTAL REGISTRATION FEE: %.i° &6 Make a copy of this form for your records Registration Cancellation Policy: Return Conference Registration and Housing Form to: All cancellation requests must be received in writing, Fax: 703 -631 -6288 (Credit Card and Purchase Orders Only No Checks) q g postmarked by February attend pa Mail: NLC Registration Housing Services, clo J. Spargo Associates, Inc. and are subject to a $75 cancellation fee. No partial refunds will be made if you decide not to attend particular functions. No registrations or cancellations will be accepted by telephone. No cancellations will be accepted 11208 Waples Mill Road, Suite 112, Fairfax, VA 22030 F More Information: after February 18, 2011 TelephoneW[3 -319 -3864 or 703 449 -6418 E -mail: nlcrea and housing(a).isparoo.com For Office Use Only: Paymen Check Amoun For Office Use Only: Htl_ Subblk_ Cate_ Rate_ Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Farm No. 201 (Rev. 1995) CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) nftch b f Total hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 IN SUM OF VA A$ ON ACCOUNT OF APPROPRIATION FOR C5, Board Members PO# or INVOICE NO. ACCT /TITLE AMOUNT DEPT I 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 a n s 20 Signature 0 Title Cost distribution ledger classification if claim paid motor vehicle highway fund