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Home My WebLink About203955 11/21/2011 CITY OF CARMEL, INDIANA VENDOR: 00351245 Page 1 of 1 ONE CIVIC SQUARE N L C REGISTRATION HOUSING SVS CARMEL, INDIANA 46032 C/0 J SPARGO ASSOC INC CHECK AMOUNT: $355.00 11208 WAPLES MILL ROAD SUITE 112 CHECK NUMBER: 203955 FAIRFAX VA 22030 CHECK DATE: 11/21/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1701 4357004 355.00 EXTERNAL INSTRUCT FEE >iwvv up iui illy wniyiieu mummy un me connrmea cravat date un ess i nove cancew my reservo Ion wirm 7 eas On-site rate includes $100 processing fee. To receive advance rate, mailed or faxed registrations must be postmarked by 72 hours in advance. I understand that if I do not show at the hotel on my confirmed arrival date, my reservation will not be March 7th 2012. Visit www.nlc.org and register online to ensure you meet the March deadline. reinstated for the remainder of the stay unless I instruct the hotel to reinstate my reservation. Reinstated reservations are subject to hotel's availability. Further, I agree to the stated Registration Cancellation policy and I understand upon cancelling my *Must attend Congress of Cities. Must include registration ID number to qualify COC Reg Id# registration I will accrue a $75 non refundable processing fee. REGISTRATION FOR LEADERSHIP TRAINING INSTITUTE SEMINARS (MARCH. 10 11, 2011) Visa /MasterCard /AmEx Number To REGISTER, codes and fees are listed at the Leadership Training Institute on the website. You must be registered for the Exp. Date conference in order to attend. You may not select a Full Day LTI and a Half -Day LTI on the some day. Card Holder Name Saturday, March 10 Full -Day Seminar Code:_ $180 Card Holder Signature Saturday, March 10 Morning Seminar Code: $120 Saturday, March 10 F Afternoon Seminar Coder $120 S Additional Credit Card Authorization: for hotel deposit only if different than the credit card number listed above. (Expiration Sunday, March 11 —Full -Day Seminar Code:_ $180 p y Sunday, March 11 Morning Seminar Code:_ $120 dote must be 3/12 or later, per hotel requirement.) Sunday, March 1 I —After noon Seminar Code:_ 5120 LTI Leadership Luncheon Code: $40 Credit Card Number 2012 CONSTITUENCY GROUP SPECIAL EVENT FEES Exp. Date Card Holder Name Any NLC registered delegate may attend by paying the fees below. Visit the website for more information on constituency Card Holder Signature groups. Asian Pacific American Municipal Officials APAMO Reception Al S35 MAKE A COPY OF THIS FORM FOR YOUR RECORDS Gay, Lesbian, Bisexual and Transgender Local Officials GLBTLO Reception G1 $50 FAX: 703 -631 -6288 (Credit Card and Purchase Orders Only— No Checks) F Hispanic Elected Local Officials HELD Reception H1 $50 MAIL: NLC Registration Housing Services, c/o J. Spargo Associates, Inc. National Black Caucus of Local Elected Officials 11208 Woples Mill Road, Suite 112, Fairfax, VA 22030 C NBC -LEO Evening Event N1 $50 Women in Municipal Government FOR MORE INFORMATION WIMG "A Capital Feast" Luncheon Wl $50 Call: 888 -319 -3864 or 703 449 -6418 or E-mail: nlcregandhousing @jspargo.com Celebrate Diversity Breakfast $35 For Office Use Only: Payment Check Amount TOTAL REGISTRATION FEE: C>6 �r Office Use Only: Htl_ Subblk Cate_ Rate Registration Cancellation Policy: All cancellation requests must he received in writing, postmarked by February 13, 2012 and ore subject to a $75 cancellation NATIONAL 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 after February 13, 2012 LEAGU E orCITIES 'r Conference Registration Form NO HOUSING OR REGISTRATION ILL BE PROCESSED WITHO ACCOMPANYING PAYMENT IN FULL. HOTEL ESERVATIONS: You must be registered for the Conference to reserve a hotel room. To guarantee your room, all hotels requir one night's deposit plus 14.5% tax (subject to change), 30 days prior to your arrival. This is required even if you plan Are you a newly elected official? Size of city? 0, to ive before 6:00 p.m. If accommodations are not guaranteed 30 days in advance, the reservation will he cancelled. Name d ({J r.4 Y" d'lease make my hotel reservation as indicated below. I do not require hotel accommodations at any of the hotels listed below. Gender Although I am providing information for a standard room for now please contact me regarding suite information. Title C—ameq d FcA rr r Room Dates: Arrival Date: parture Date: Room Type: Single, 1 person /l bed [_3 Quad, 4 people /2 beds City /Organization Double, 2 people /l bed Double /Double, 2 people /2 beds ,o Triple, 3 people /2 beds Mailing Address V /V 16 Room types cannot be guaranteed but hotels will attempt to accommodate all requests. Sharing My Room With (for Hotel Check In Purposes): City State zip 6 Special Housing Request (e.g., wheelchair accessible rooms, etc.): Phone Fox If you have special housing or transportation needs, please contact NLC Meeting Services at 888 -319 -3864 or 703 449 -6418 Email (/l, d Hotel Choices: Indicate your first choice hotel with the number "1 Number hotels in order of preference. The Marriott Registrant's Email Wardman Park Hotel is the headquarters hotel. Order Hotel Smoking NLC Rate Youth Delegate Property Single /Double/Trip /Quad Marion Wardman Park No S249/S249/5/269 /$289 Name A 9 e Omni Shoreham No S247/S247/967/5287 Chaperone Name Age REGISTRATION FEE PAYMENT INFORMATION SPECIAL CONFERENCE RATES U� urge my REGISTRATION FEES to VISA, MasterCard or AmEx listed below Spouse /Guest (non refundable) 50 [}'Check for REGISTRATION FEES mode payable to National League of Cities First -Time Attendee $350 U Purchase Order for REGISTRATION FEES copy must be enclosed payment must be received by February 13, 2012. Youth Delegate 05 -18) $100 Youth Chaperone (not applicable to elected officials) $100 HOTEL DEPOSIT PAYMENT INFORMATION (YOU MUST CHECK ONE): Students $125 L] Charge my HOTEL DEPOSIT to the credit card listed below. All major credit cards with expiration date of 03/12 or later R re accepted by the NLC official hotels. REGISTRATION FEES: ADV_AN ON -SITE @(0(* N Check for HOTEL DEPOSIT. I understand check deposits for hotel room guarantee is payable to the hotel stated on the NLC Valid Starting 3/8/12 Valid unti 1 confirmation and must be mailed after February 7, 2012 but before February 17, 2012 and are subject to approval. 1 NL( Member City 5 $545 2 Associate Member Please include your 6 -digit REG ID #indicated on the NLC Meeting services confirmation. 3 SML Member City $565 $665 $355 4 Non Member /Othe $430 Credit Card Authorization: NLC Registration and Housing Services is authorized to use the card below to pay all applicable S670 5770 ce7s c registration fees and Guarantee my hotel reservation. I understand that one night's room charge will be forfeited if I fail to 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. Payee L Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 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. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. 00j--H y ALLOWED 20 IN SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or D PT. INVOICE NO. ACCT #/TITLE AMOUNT 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 20 Signature Cost distribution ledger classification if Title claim paid motor vehicle highway fund