HomeMy WebLinkAbout200703 08/17/2011 CITY OF CARMEL, INDIANA VENDOR: 143001 Page 1 of 1
ONE CIVIC SQUARE INDIANA ASSOC OF CITIES TOWNS
(i CHECK AMOUNT: $275.00
CARMEL, INDIANA 46032 CONFERENCE REGISTRATION
200 S MERIDIAN ST, SUITE 340 CHECK NUMBER: 200703
INDIANAPOLIS IN 46225
CHECK DATE: 8/17/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4357004 275.00 EXTERNAL INSTRUCT FEE
2011 ANNUAL CONFERENCE REGISTRATION FORM
1. Registrati Deadline: September 22
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Full Name �l� r City orTown /State /Zip
Preferred Name for Badge Phone C I
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Title v� V r� Email
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First Time Attendee? Yes ;A0 Spouse /Guest Name
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Municipality /Company colt n Special Needs and Dietary Restrictions
Council President's Name 1 vx d',
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Address
Registration Fee M thod of Payment
On /Before After EnterAmount
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9/22 9/22 1 4heck Visa MasterCard Discover
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Member Municipal Official (Population $275 $325 11 Check (Payable to TACT)
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greater than or equal to 1,000) f
Member Municipal Official (Population S175 $225 Cardholder Name
less than 1,000)
Credit Card Number
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Associate Member $275 $325
Expiration Date
Spouse /Guest• $175 $225
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3 -digit Verification Code
Non Member $425 $475
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Billing Address
Municipal Day (Monday Only) $225 $275
City orTown /State /Zip
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Total Amount Due:
Signature of Cardholder
*The spouse /guest registration fee is restricted to those who are not municipal officials and who have no professional interest at the conference. The
fee includes admission to all conference events, the exhibit hall, meals and participation in the spouse /guest program.
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PI ase Check the Conference Events You Pan to A 'end
Sunday, Opening Sunday, Early Sunday, Early Sunday, Wel- Monday, Conti- i *Monday, onday, Presl- Tuesday, Closing
Business Session Bird Workshop #1: Bird Workshop come Reception nental Breakfast Annual Awards dents' Reception runch Business
Understanding #2: Managing Luncheon Session
your Municipal Change in a
Code Enforce- Changing World
ment Tool Box
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*This year's IACT Annual Awards Luncheon will have assigned seating. Only registrants who check the Annual Awards luncheon above will be assigned a seat. We will do our best to
accommodate seating requests. Requests are not guaranteed.
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Seating Requests;
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Cancellation Policy
Only written cancellations will be accepted. Please mail your written cancellation to 200 South Meridian Street, Suite 340, Indianapolis, IN 46225; fax to
(317) 237 -6206 or send to nhurt @citiesandtowns.org. Written cancellations received on or before September 29, will be refunded less a $40 processing
fee. IACT is not responsible for hotel reservations or cancellations.
Special Needs and Dietary Restrictions
IACT will make the conference accessible to you. If you require special arrangements or a special diet, please notify IACT on your registration form. We
may not be able to accommodate such requests made the day of the event. Meeting room temperatures may vary beyond our control; please wear layers
of clothing for your comfort.
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Affiliate Group Events
IACT affiliate groups may hold individual meetings and events at the conference. Attendees must be registered for the conference in order to attend affili-
ate events. Additional meeting and event information for affiliate group members may be mailed out separately.
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.
P pee
)q�5 S y
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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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.
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Clerk- Treasurer
VOUCHER NO. WARRANT NO.
yu W d 7 ALLOWED 20
/'11W- IN SUM OF
34
ja S W6 A-
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ON ACCOUNT OF APPROPRIATION FOR
r7 -4`7 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
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Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund