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Home My WebLink About201293 09/13/2011 CITY OF CARMEL, INDIANA VENDOR: 175950 Page 1 of 1 0 ONE CIVIC SQUARE BRUCE KNOTT J CARMEL, INDIANA 46032 29393 N. HAYWORTH ROAD CHECK AMOUNT: $44.00 's r ATLANTA IN 46031 CHECK NUMBER: 201293 CHECK DATE: 9/13/2011 DEPARTMENT ACCOUNT P O NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4343002 REIMB 44.00 EXTERNAL TRAINING TRA 2011 Indiana F`nier{gency Response Conference RegOnline 'axle I of r 4;wkne, w1th .l.ttt.Ha U'llivt, l ._Jt.tV fl( {Lth.. FIRE *E IS LA W ENFORCEMENT HAZMA T SPECIAL OPS L EPC 2011 Indiana Emergency Response Conference Wednesday, August 17, 2 1 Saturday, August 20 2011 Indiana Convention Center 100 South Capitol Ave Indianapolis, IN 46225 United States 317- 262 -3400 Event Details Phone; 317- 733 -1850 Email: rake (cbindianaerc.com Personal information Agenda Hotel Information Individual Event Tickets Checkout Confirmation Thank you for registering for the 2011 Indiana Emergency Response Conference, a partner with Indiana University Health. Please print out your schedule (click "Printable Schedule" in the right -hand column of this page) and bring it to the conference. Your schedule will not be available at the conference regkstration desk. Workshop Certification PLEASE NOTE: Participants who need to track course attendance for certifications WILL be able to obtain a printout online after the conference. A link to a website will be provided that allows attendees to access their certificates online using their email address for verification. The site stays up for a minimum of six months. litt'l) wry Nv.re,(�ronl�irie.coiit/ret,ister /coif rn�,+fiion.rrsi,)x ?Evcntldl= 959 306&AI..terldeeld= -wsli(7.X I I I I`... 61 �4 vto1. lobu.UUi Transaction Summary 20| /ndkmu ouy Response Conference Rcg{}n|ioo Page 3 o[, Payment Information Payment Method: Invoice Payment Payment can be made via credit card, check or invoice. For check or invoice, print m Instructions: copy of your invoice and mail it with your payment tm the address below. Please write your Registration ID Number (located on your confirmation) on the check for faster processing. Please note: payment must be received prior to the conference or at registration for admittance. Remit Payment To: |FCA Address: P[> Box 304.Zionsville, IN 48077 Telephone: 1-877-733-1850 Fax: (317) 733-4212 E-Mail: If at any time you would like to return to a previous page during the registration process, please right-click and choose ^8acK' You will also have any opportunity to review and/or change your information as well as add additional attendees at the end ofthe registration process, If you have any questions or concerns during or about the online registration process, please contact Melody Sorg via email utmmong@indionaem.comor via phone at317-4O0-O204, For more information, please visit our conference web site ad hapc//vpwvv.ref,on|ino.00zn/ncgiyncotooOnnnhno.unpx?Evon8d=959')O0&Alk:ndceid=\VubD}{\y)L. 6/l6/20\\ please visit the conference web sit at yvww.tndianaER C�. .r1r��m to reoistr>_r a smg our simple and secure online form, The wet? site will have a detailed listing v' fl ed =ucational tracks including descriptions of ecarh (.',ourse, speaker information and times for each class. YOU Call also submit Awards Nominations „alike your He "Iel Reservation, downfoaci Maps and find Parking options on the wet) site. if you don't have access ir. the Internet, you May use the registration form below, Please note thai it will take 2 -a weeks to process your registration using this form. Pieascs print clearly in BLOCK LE I I' °ERS and prinUtype and co ?replete all srr;etions of the forni. Use one form per fegislrana.; photocopy additional fOrmW as nee -pled. Early Registration ends July 2601, There will also be an Opportunity lf> ofi-sro registra,Won August 17 20. BadgelRegistrant I 711!� ation 1. Full Conference Registration F irs t trsclaadc:.d with foil registration: r�.. ne M I. Last Name More educational opportunities than ever, with over �i� 100 outstanding courses! 3.._...............11.1.. e as t s to appear on ac +ue FREE cafucation I day on 'Wednesday, Augu*,t 1 1 with i S 1, V° Randol at LMntoot t Dr. Brycan Bledsoe and Sims Tour rsith Imr DeprartmentiCornpany h?d? an, University Health 5_L c Meals. Thursday Evening Casino Night meal and Friday Lun ch Street taddress c:.ny StatelZip with the Vendor. Due to budget restraints, not all meals are 3%7- 5 7 -cI I r7 �`7 included in the registration fee as in years past. Please see Event .m Phone Fax Mobile Functions below to purchase tickets to the Awards Banquet. r' L' You car register for the August 17th golf outing alonc with your ft 11 E,,,r,'ai A;3cfress ,1t�e l .vnfercance registration w. Please register foursomes individually. S'"7 (Check yoot pre;frara aces helow, Early Registration Ends July 261h.) Your Department's Fire Marshal Phone i 1 }J F J C'd j Earl y Full Conference with GoW 5205 Your P c Educatioaa Reprc�e �aiivets) P3acxan Early Full Conference without Golf: $150 Are you affiliated witti any organizations? f /ease f,•* >f on the 1irt +es below, y. G L_ Late Full Conference with Golf: S255 I Late Full Conference without Golf: $200 y P£cfess one l iRE EMS 1 LAW Conference Registration Total: .S Combination Other Hanuic<ap frf registering for Golf) 2. Special Classes Gender: M;aie _..._i Fcmale 'Householef Number Pre re gistration required. Must be registered for full or On-Site Emergency Information one. conference to attend these specials. AMLS: 18 person limit, $20 special registration fee, course book purchase r =squired for class {Contact: Julia Fox at :317 -962_ -5122 or u yr re will you of staying during the conf erence? fl; $o7itahc :ahh.Orr� iv ?th questions about fl ill r ourse. i S AD r IU Health Cadaver Practical Skills Lab: 20 person limit, I'larne of person to contact an case of em ergene v �`f S250 special registration fee (Contract: Melissa Ho kaday at 3 17 Kc,l<'atir��i�taip t. Ernrrrlenry Cora ac? f'y r of d bout this C s n1hOrkad�avirr i u a alt;7.p� mt#a rur5ilons Tactical Medicine: 20 person limit, FREE (Contact Tony Stimosr Meals at 260 -701 -010 i or SL?.1ac;kysJ�4s with q uelstiorts about this course,) Pieaase indicate which are als you plan to attend, including spouses ,andiur g uests, to help provide an accurate pent. count. A� class size is Cmitecf. plea—so, mark which classes you would like ittend. Thursday Casino Night AMLS Vendor Shove Lunch: Friday lU Health Cadaver Practical Skills Lab at Methodist Hospital i do not lil<`an to attend any meals. Tactical Medicine Special Classes Program Total: S._ _�r t x r Reglst r tlnline at wwW Iracitatsa RC1qdnv v 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)) $44.00 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. W NO. ALLOWED 20 Bruce Knott IN SUM OF $44.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 I I 43- 430.02 I $44.00 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 SEP 12 2011 n Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund