168336 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 365652 Page 1 of 1
ONE CIVIC SQUARE AMERICAN CAMP ASSOCIATION
CARMEL, INDIANA 46032 5000 ST ROAD 67 NORTH CHECK AMOUNT: $581.00
MARTINSVILLE IN 46151 -7902 CHECK NUMBER: 168336
CHECK DATE: 2/4 /2009
,lJ EPARTMENT ACCOUNT PO NUMBER IN VOIC E NUMB DESCRIPTION
1046 4355300 48872 581.00 ORGANIZATION MEMBER
T.-
9/18/I008 3 Operator 2851
american association®
Camp Fee and Membership Renewal Invoice
Return this form with corrections and remittance to: Pumhm American Camp Association, Inc.® Descriptldfl
5000 State Rood 67 North P 0 P
Martinsville IN 46151.7902 L
765 342.8456 fox 765. 342.2065 G.L t➢
Bud
e•moil membership@ACAcomps.org Line De3af
urchaser
Local Office Indiana !',pprOVal Dat
Expiration 2/29/2008
Affiliation Government, Local Camp Operator Ben Johnson
Carmel Clay Parks and Recreati
1235 Central Park Drive East
RECEIVED Carmel IN 46032 -7569
JAN 2 2 2009
Phone (317) 848.7275 Fax (317) 571.5254
BY' E -mail biohnson @carmelclayporks.com
Web Address htip /www.cormoicloyporks.com
#1 Camps: Accreditation services are included for up to four camps. If more than four are seeking or maintaining
accreditation, add S100 for each additional camp,
Comp
ID# Camp Nome Accreditation Status
48872 Carmel Clay Parks Recreation Camp Affiliate
Current Expiration Date 2/29/2008 ACA Liaison: Ben Johnson 57437
IA: Please list other camps you wish to be separate Camp Affiliates of ACA or ACA Accredited Comps. Please
note that camps listed here seeking accreditation will require separate accreditation visits. Include these camps in
your camp fee calculation: Attach additional sheets if needed
Name and Address of Camp Seeking Accreditation ACA Liaison for Camp (must be o member)
Y or N (See enclosure for
deadlines)
#I B Camp Fee (see Camp Fee Table) S
#1C Additional Accredited camps or camps seeking Accreditation add $100 for each camp after 4 S
#I D Camp Subtotal
Camp Fee Table
From column "A" select the dollar amount that represents the greater of your gross operating income or gross
operating expense from all sources for the camps listed. Column 'B" is the number of professional memberships
included with your camp fees. Column "C" is the amount of your fees. Place amount from column "C" on line
#1B.
A B C A B C A B C
SO-S25.000 1 S581 $700,001 S800,000 2 51899 $6,000,001 S8,000,000 7 53270
$25,001 $50.000 1 5632 $800,001 S900,000 2 $2059 58,000,001 $10,000,000 8 S3481
S50,001 $100.000 1 $792 $900,001 $1,000,000 2 $2215 $10,000,001 $12.000,000 9 53693
S100,001 $200,000 1 $950 51,000,001 $1,500,000 3 52480 $12.000,001 514,000,000 10 53904
$200.001 $300,000 1 51160 $1.500,001 $2,000,000 3 52636 $14,000,001 $16,000,000 11 $4115
$300,001 $400.000 1 $1215 S2,000,001 S3,000,000 4 $2798 $16,000,001 $18.000,000 12 $4327
5400,001 $500,000 1 51320 $3,000,001 54,000,000 5 52954 518.000,001 520,000,000 13 $4538
520,000,001 Please call the National
$500,001 $600,000 2 $1688 $4,000,001 S6,000,000 6 53114 Office for these rates.
9/18/4008 Operator 285
$600,001 $700.000 2 51794
#2 ACA Members affiliated with your camp or organization
#2A Members: Please place a check mark to indicate if the Professional Membership is included in your Camp Fee, or if you
are paying for the extra membership. See the Camp Fee Table for the number of included Professional Memberships.
Additional Professional Memberships are $150, Associate Memberships ore $100, (Associate Members who are Standards
Visitors, Retirees, Volunteers $50), Student Memberships are $35. In this area, please write in any other ACA members that
belong to your organization that are not listed.
Professional, Associate Please Indicate
or Student Member Affiliated with Included in Operator 'Individual
ID Member Nome Comp Camp F a Paying Paying Amount
57437 Ben Johnson 48872 S
51N PROFESSIONAL MEMBER Current Expiration Date 2129/2008
#21) New Additional Members: Please fill out the information below for other persons you wish to add to your membership list.
Attach additional sheets if needed. Please place a check mark to indicate if the Professional Membership is included in your
Comp Fee, or if you ore paying for the extra membership. See the Camp Fee Table for the number of Professional
Memberships. Additional Professional Memberships ore $150, Associate Memberships are 5100, (Associate Members who are
Standards Visitors, Retirees, Volunteers $50), Student Memberships are $35. All new members will receive a Member
Information Update Form with their member ID cards.
Professional, Associate
or Student Member Affiliated with Included in Operator Individual
Name and Address Camp Camp Fee Paying Paying Amount
Please indicate if one of the following apply:
Standards Visitor Retiree Volunteer Full -time Student
#2C Add all amounts from #2A and #2B Membership Subtotal S
#3 Elective Dues and Contributions for ACA Liaison
#3A Religiously Affiliated Comps Council
........$35
Open to any ACA member at a religiously affiliated camp. Offers newsletter, surveys, and networking.
#3B Not for Profit Council ............................$25
Open to any ACA member with a nol for profit affiliation. Offers a newsletter and kindred meetings.
#31) Elective Dues Subtotal S
#4A ACA Annual Fund Suggested Contibution S_250.00_
Thanks for your tax- deductible contribution) ACA work goes beyond what comp fees and membership cost. Research about
camp enrollments, Find -o -Comp tools for helping parents find your camp, and cuffing -edge technology assure we get up -to.
dole information in your hands just when you need if. These ore all programs that need your support!
Indicate how acknowledgement must appear in letters and in publications:
i Verification: Stopl Read this sectionl
By submitting payment, I affirm that:
the statements mode on this renewal are correct Camp Subtotal (#I D) S S8�
I meet the requirements for the membership category
I have chosen; Membership Subtotal #2C) S
I have rood and agree to abide by the Code of I Elective Dues Subtotal #3D) S
Ethics for All Members of the American Camp Suggested Contributions Subtotal #4A) S39^
Association To tal R``emitton�ce' "S, 5
www.ACAcomps.org /membership /elhics.htm) Individual Completing Form:
I understand fees are renewable annually (They
cannot be refunded or transferred to another individual Payment Method
or to next years services.); and -Pi'
for lox purposes, ACA fees may be deductible as a Check or Money Order Enclosed
i business expense, but are not deductible as o Bill my _VISA MasterCard Discover
charitable contribution.
Acct. No.
The American Comp Association is o voluntary Expiration Date Security Code
association that reserves the right to decline
membership for any or no reason. Signature
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
American Camp Association, Inc. Terms
5000 State Road 67 North
Martinsville, IN 46151 -2065
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/18/08 48872 Membership fees 581.00
Total 581.00
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.
American Camp Association, Inc. Allowed 20
5000 State Road 67 North
Martinsville, IN 46151 9 9D2-
In Sum of
581.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #MTLE AMOUNT Board Members
Dept
1046 48872 4355300 581.00 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
27 -Jan 2009
t f�qim/m
Signature
581.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund