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162886 08/20/2008 I CITY OF CARMEL, INDIANA VENDOR: 361677 Page 1 of 1 ONE CIVIC SQUARE NATO A PO BOX 826127 CHECK AMOUNT: $1,170.00 CARMEL, INDIANA 46032 PHILADELPHIA PA 19182 -6127 CHECK NUMBER: 162886 CHECK DATE: 8/20/2008 DEPARTMENT ACCOUNT PO NUMBER I NVOICE NUMBER AMOUNT DESCRIPTION j 1160 4357004 1,170.00 EXTERNAL INSTRUCT FEE i I r ry,.. E's= nnsrz:rsi �trtassotast' ..twztws, n F,i <.;<t o,:fustt �IED�➢:.G66:61 J4 .•a .::7e..: Y 'iri:,•' ?i- `..`.'4 ��d: wnsm i .��.r'�„' fy W OOD a� s a r ii 'w.-i: �AW3«.••t: nxc wnn rnngdnnunx,. 'C t i W ill Jill! III ll�� ill 1 1 If paying by credit card, you may also register for the conference online at www.natoa.org Please print or type. Use a separate form for each person registering for the conference. Full Name First name preferred for badge 1V a n C Title C S Department Agency /Company C V C e�_( +M et �Lnill O—V\ CL Address e 'i l L q A s City /State /Zip r4 "T' L A L 2 g Telephone 2 �y Fax l D E -mail CAv me REGISTRATION FEES OPTIONAL SESSIONS For NATOA planning purposes, please Indic he track that you are most Please indicate the activity in which you wish to participate likely to follow: Community Networks ePolicy and Legal Programming First Time Attendees Meeting Please join us at this meeting if this is your FULL CONFERENCE first time attending a NATOA conference no charge Full conference registration includes admission to all educational sessions, exhibits, Community Networks Primer (By reservation only) no charge luncheons, refreshment breaks, receptions and handout materials. It does not Policy and Legal Primer (By reservation only) no charge include optional activities or meals for guests. Programming Primer (By reservation only) no charge Registration Registration 7/16/08 Aker 8/29/08 Community Networks Masters Class (By reservation only) no charge until 7/ until 8 /29/08 Ppacy and Legal Masters Class By reservation only) no charge NATOA Member $575 $625 $675 VP4ramming Masters Class (By reservation only) no charge NLC Primary Member/ $575 $625 $675 Programming Track All Day Storytelling Workshop Elected Official Saturday, September 20 (By reservation only) $25.00 Government Non Member/ $675 $725 $775 Non -Profit Tech Showcase— Te1Vue Corporation Non Member Private Sector $775 $825 $875 T ursda Se tember IS B reservation onl no charge Tech Showcase— Granicus ONE OR TWO -DAY REGISTRATION Friday, September 19 (By reservation only) no charge One or two -day registration includes that day's concurrent educational sessions, Joe Laposa Golf Tournament, Tuesday, September 16, 2008 $100.00 refreshment breaks, any meals and handout materials. Optional activities are not included. You may register for one or two days, otherwise you must register for FAMILY AND FRIENDS GUEST REGISTRATION the entire conference. All meals for the registrant are included with full conference registration. Wednesday Thursday ridgy &r1aturday If you have registered for the full conference, it is not necessary to purchase Registration (Per Day) additional meals for yourself NATOA Member: $250 All Meals )includes -3 breakfasts $275.00 NLC Primary Member/ $250 Thursday Keynote Luncheon 45.00 Elected Official Government Non Member/ $280 Thursday Welcome Reception 50.00 Non -Profit Saturday Keynote Luncheon 45.00 Non Member Private Sector $350 Saturday GPA Awards Banquet 80.00 ANNUAL BUSINESS MEETING TOTAL CONFERENCE PAYMENT 0 Please indicate your intent to attend the Annual Business Meeting Please include all categories checked, i.e., registration fees, extra meals, and new member dues Total: SS5 .0c) ACCOMMODATIONS FOR PEOPLE WITH DISABILITIES: NATOA wishes to ensure that no individual with a disability is excluded, denied services, segregated or otherwise treated differently from other individuals because of the absence of an auxiliary aid or service. If any auxiliary aid or service identified with the Americans with Disabilities Act is required, please contact NATOA Headquarters at info @natoa.org or )703) 519 -8035. SPECIAL DIETARY NEEDS: Please indicate here or email info @natoa.org if you require special dietary needs, such as diabetic, kosher, vegetarian, etc. Dietary requests such as Atkins or South Beach cannot be accommodated. Contact NATOA Headquarters at info ®natoa.org or (703) 519 -8035 if you have any questions. CANCELLATION POLICY: Conference Registration: Full registration fee minus a 25% service charge will be refunded if cancellation is received in writing at NATOA Headquarters no later than Friday, August 29, 2008. No refunds will be made for cancellations received after Friday, August 29, 2008. Substitutions are permitted and encouraged in lieu of cancellation. You may fax your cancellation to (703) 519 -8036. PAYMENT INFORMATION Please note that actual payment must be received by the date indicated in order to receive the registration rate. If your registration form and payment are not received by the date indicated, the correct (higher) fee will be applied. A purchase order does not constitute payment. If paying by check, complete and return this form with payment to: NATOA, P.O. Box 826127, Philadelphia, PA 19182 -6127 Registrations paid by credit card or Government PO may be faxed to (703) 519 -8036 Government PO No If paying by credit card, you may also register via our web site at www.natoa.org CREDIT CARD INFORMATION: VISA MasterCard American Express Credit card number Exp. date Cardholder name Signature E." if paying by credit card, you may also register for the conference online at www.natoa.org Please print o, type. Use o separate form for each person registering for the conference. Title 6)L\ Department n as Agency/Company cc t -As MPA REGISTRATION FEES OPTIONAL SESSIONS For NATOA plannin purposes, please indicate the track that n��m��"��m��* uk"�w�uv uo"=="��m"*°"�" omu, Le ��=�ra=mi" u First Time Attendees Meetin join this meetin x this i° FULL CONFERENCE Full �a"a�°�m��" °u"a�"�""a"��" exhibits, u s m luncheons, refreshment breaks, receptions and handout materials. u does not U Policy and Legal Primer (By reservation only) no charge include optional activities or meals for g uests. Pr ogramming Primer (By reservation only) no charge Registration Re After8/2 Community Networks Masters Class (By reservation only) no charge until 7/15/o8 until 8/29/o8 �3 Poecy and Legal Masters Class (By reservation only) no charge NATOA Member $575 $625 $675 �<Wamming Masters Class (By reservation only) no charge sLc Primar Member/ $ors 000v s675 V'P rogramming Track All Day Storytelling Workshop— Elected o°e,"m.=^m""'wemb"r/ usrs ,rus $rrs Non-Profit ^~^~~~`^^^—^~`^^^~'y`^~~^^ Non-Member Private Sector $775 $825 $875 Jersday, September 18 (By reservation only) no charge ONE mm TWO-DAY REGISTRAT Friday, September 19 (By reservation only) no charge One two-da re includes that da concurrent educational sessions, U Joe Laposa Golf Tournament, Tuesday, September 16, 2008 $100.00 refreshment br"ak"" included. You ma re for one or two da otherwise y ou must re for FAMILY AND FRIENDS GUEST REGISTRATION the entire conference. All meals for the re are included with full conference re uvea""sd" or»",sd" oa/a" Uo"mrd"x vv"" have re for the full conference, ois not necessar mpurchase additional meals for y ourself NATOA Member: $250 All Meals (includes 3 break $275.00 NLC Primar Member/ $xoo Thursday Keynote Luncheon $45.00 Elected Official Government Non-Member/ $zov Th Non-Profit Saturday Keynote Luncheon 45.00 Non-Member Private Sector $350 Saturday GPA Awards Banquet 80.00 ANNUAL BUSINESS MEETING TOTAL CONFERENCE PAYMENT o Please indicate y our intent w attend the Annual Business Meeting Please include all cate checked, i.=. re fees, extra m=u. ""u"°° member d ues n"tal.s ACCOMMODATIONS FOR PEOPLE WITH DISABILITIES: NATOA wishes to ensure that no individual with a disabilit is excluded, denied service se or otherwise treated differentl from other individuals because o/ the absence auxiliar aid service. /f an auxiliar aid service identified with the m""ri=""°ith Disabilities Act u re please contact mxrox Head "^i"fo@""w""r SPECIAL DIETARY NEEDS: Please indicate here m email /"fo@"m".mr y ou re special dietar needs, such as diabetic, kosher ve etc. Dietar re such "o Atkins o, South Beach cannot b" accommodated. Contact Nmox Head ",i"fo@""m".o, y ou have an q uestions. CANCELLATION POLICY: Conference Re Full re fee minus "zs% service char will be refunded a cancellation i, received writin "^ymoA Head later than Frida Au xo.uvva.m" refunds will be made for cancellations received after Frida Au uo.u000. Substitutions are permitted and encoura i" lieu of cancellation. You ma fax y our cancellation w(roas1v'ooaa PAYMENT INFORMATION Please note that actual pa must a" received a the date indicated i" order receive the re rate. xf re form and pa are not received a the date indicated, the correct (aio*,,) fee will b, applied. a purchase order does not constitute pa Ifp bp check, complete and return this form with pa to: mmoA.uo. Box noo.ur Philadelphia, rxmmx'o`ur Re paid b credit card Government ,o ma b" faxed m(roo)s'v'0000 Government PO No I/«^vingav credit card, you may also re via our web site u/°w°."uxm."nx CREDIT CARD INFORMATION: Q VISA U MasterCard Q American Express Credit card number Exv. date Cardholder name Signature Prescrib(M by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER 8/18/08 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 NATOA Purchase Order No. P. 0. Box 826127 Terms Philadelphia PA 19182 -6127 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 8/18/08 Stmt NATOA Conference fee for Nancy Heck 585.00 8/18/08 Stmt NATOA Conference fee for Michelle Krcmerc $585.00 Total $1,170.00 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. 8/18/08 ALLOWED 20 _NA10A IN SUM OF P. 0. Box 826127 Philadelphia PA 19182 -6127 f,f7n nn ON ACCOUNT OF APPROPRIATION FOR 1160 Mayors 4357004 External Instruction Fees Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or Stmt 4357004 $1,170.00 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 Apature Cost distribution ledger classification if Title claim paid motor vehicle highway fund