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Home My WebLink About168529 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 362489 Page 1 of 1 ONE CIVIC SQUARE INDIANA FIRE CHAPLAIN CORPS INC CHECK AMOUNT: $190.00 a CARMEL, INDIANA 46032 15 E MAIN STREET NEW PALESTINE IN 46163 CHECK NUMBER: 168529 CHECK DATE: 2/412009 DEPARTMENT AC COUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4357004 FCT -903 190.00 EXTERNAL INSTRUCT FEE I -t. Indiana Fire Chaplain Corps, Inc. 15 E. Main Street New Palestine IN 46163 Sponsor of Great Lakes Fire Chaplain and CISM Training Institute EIN:30- 0345038 I N V O I C E Date: 012109 INVOICE NO. FCT -903 To: Denise Snyder, Budget Manager Carmel Fire Department For: Great Lakes Fire Chaplain Training Institute Registration for: Douglas J. Kizer Basic Level 100 Chaplaincy course (16 hours) X CISM Pastoral Crisis Intervention Fire Families Tuition for Class checked above 150.00 X FFC /IFC Membership paid with Enrollment in GLFCTI -75.00 FFC Training Manual for Basic Class -59.95 Training Manual for Pastoral Crisis Intervention 20.00 X Noon meals served on site for the two -day seminar----------------------------------- 20.00 X Total Amount of Invoice 190.00 Tuition for the Institute Fire Chaplain CISM Training Institute Tf Federation of Fire Chaplains Basic Level 100 CISM or Advanced Class Registration, April 20 -21, 2009 Presents lire Institute Tuition----------------- $150.00 Name (�c9u4I �aS J �IZe&' Spouse'rUition for Fire Families 75.00 Great Lakes Regional (as you want to appear on your certificate) Non -FFC Members may include the annual Address I y04 G 1 -3 1 s_f Sf City >sh Fire Chaplain CISM membership fee of $75.00 for FFC with registration, and get a FREE 1 year annual State Zip 46o3 "1 membership in the Indiana Fire Chaplain Corps. Contact phone 3l 20 I 14,1q Training Institute Email Address: Ao uq Ktz v 6 iiyr .o v A copy of the Federation of Fire Chaplain Training Please enroll me for the: Hosted by 1 Manual may be ordered for $59.95 plus $10.00 for Basic Level 100 Class (2 Days). postage and handling ($69.95 total). 1 Pastoral Crisis Intervention (2- Days) 7&1ndiana Fire Chaplain Corps 0 Fire Families Class 2 -days) F A copy of the PCI Participant Manual (required) and your certificate from the International Critical 1 am NOT a member of the FFC IFC❑ k w Incident Stress Foundation is $20.00, in addition to and would like to become a member with my r your tuition for the course. registration for the Institute (Please send me application(s) f" Lunches will be provided for both noon meals at the meeting site for $10.00 each ($20.00 total), if ordered I would like to place an order for a copy of the in advance. FFC Basic Training_ Manual ($69.95) Accommodations The PCI Training Manual ($20.00) a You are responsible for your own lodging. gl would like to order the two noon meals Monday and T There are several hotels located just off 1 -465 near i� o= o y Tuition Enclosed--------------- April 20 -21, 2009 the training facility. Win Wingate Inn Airport, Rockville Rd 317 248 -9069 Tuition for Spouse FC/IF g p One Year Membership, FFC /IFC at the Sleep Inn, Rockville Rd 317 247 -4100 Cost of Training Manual----- ';L-a aC? Comfort Inn, Rockville Rd 317 487 -9800 Wayne Twp. Fire De artmel2t Cost of two noon meals �-d 00 Best Western, High School Rd 317- 246 -1505 Total Enclosed N O oo Headquarters education Days Inn, Fortune Dr. W. 317 -248 -0621 Adam's Mark, Executive Dr 317- 248 -2481 Please make checks payable to: Center Ramada Indianapolis Airport 317- 244 -1221 Indiana Fire Chaplain Corps 700 N High School Rd Radisson Indianapolis Airport 317- 244 -3361 Indianapolis, IN 46214 Mrril registration to: Travel Directions to Training Site Jim Burns, Institute Director Wayne Twp Fire Department Headquarters Great Lakes Fire Chaplain Training Institute Contact: Jim Burns (3 18) 627 -2575 Training Center is located just off 1 -465 on the 303 Pant Street Burns303702@bells0ttth.net west side of Indianapolis, at 700 N. High School Colfax, LA 71417 for additional information Rd. Exit 1 -465 at Exit 13B, only a few minutes from the Indianapolis International Airport and Please complete registration form for each person enrolling west side hotels. There are plenty of restaurants Write (spouse) beside name above for spouse. a few miles west on Rockville Rd (US 36).a a t n/ The GLFCTI is offering the Basic Level 100 To recognize the "crisis of faith" Advanced Fire Chaplaincy Cltaplainev, Pastoral Crisis Intervention I, Psychological intervention and Fire Families classes this year. Liaison intervention Fire Families is a sixteen hour class for Spiritual intervention and chaplains who have completed the Basic Level Basic Level 100 Fire Chaplaincy Religious intervention 100 class. This class deals with ministry in and to use the SAFER -R -PCI model of crisis around fire families. Spouses and significant Topics to Include: intervention with individuals others are strongly encouraged to enroll for this to understand and use 5 PCi class. Credit for this 16 hour class can be ❖Foundation and History of Fire Chaplaincy interventions Applied toward the FFC Advanced Chaplain ❖The Personhood of the Fire Chaplain review most common mistakes Certificate. ••r The Fire Chaplain's Ministry to Firefighters review self -care issues and more •9The Fire Chaplain's Ministry to Crisis Victims In this class you will learn: ❖Beginning a Fire Chaplaincy Program This two -day course consists of 13 hours. about stressors and personality traits of •3 Fire Chaplain Operations The instructor utilizes an interactive method firefighters, •:•CISM Overview of instruction, utilizing the manual, multi- ❖critical incident stress ❖Firefighter injury and Death Notification media presentations, videos, role -play, skill gender differences in communication ❖Fire Service Funeral Procedures building exercises, case studies, etc. to ❖verbal and non verbal communications ❖Confidentially and HiPAA achieve the objective. This two -day course 4-helping families survive builds on Group and Individual CiSM the dynamics of change in families Tile Basic Level 100 Institute includes 16 hours courses. ❖conflict management and forgiveness of basic chaplaincy classes affording participants ❖management styles and resulting stress opportunity to gain introductory information and Participants are required to purchase the and more. education on topics important to the fire Pastoral Crisis intervention Course Workbook. chaplaincy. All classes are taught by Federation The PCI class is taught by ICiSF approved This class is led by Master Chaplain and FFC of Fire Chaplains certified instructors. instructor: Glenn Calkins, M.Div., CCSW, certified instructor Cameron Brown. Cameron one of the authors of the course workbook. has been a firefighter /EMT for more than 20 years The CISM Track and a chaplain since 1990 with the Fort Worth, Please Note: Texas Fire Department and currently serves as Pastoral Crisis Intervention treasurer for the FFC. Overview: Briefly PCI is the functional Enrollment in the PCI class must be no Spouses and significant others may attend for If there is 2009. integration of the principles of psychological later than March 20, tuition ($75.00). Meals and other fees apply. crisis intervention with the principles and NOT sufficient enrollment by this date, support Everf the class will be cancelled. Dress Code: Those attending the institute are P ractices of pastoral PP t y 2002 encouraged to dress comfortably. Since the It is one of the components of the CISM weather is unpredictable in Indianapolis in April, system. Note II: Payment must be received prior you will want to bring a light jacket (or a heavy Participant in the PCI class will learn: to class opening, unless arrangements are coat). The nature of human crisis made in advance to pay at the door. No The nature of crisis intervention full refunds will be made. A cancellation Registration begins at 8:00 am. On Monday. Be able to recognize signs of crisis Classes begin promptly at 9:00 am both days. g g fee of $25.00 will be deducted from. any Basic criteria for psychological triage and all refunds. Assessment and screening Ir. r• i Prescribed by State Board of Accounts City Form No. 201 (Rev. 1 995) ,w 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)) FCT -903 Regis. Fees Chaplain Kizer $190.00 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 N ALLOWED 20 1•ndiana Fire Chaplain Corps, Inc. IN SUM OF 15 E. Main Street New Palestine, IN 46163 $190.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 FCT -903 43- 570.04 $190.00 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 FEB. 2 no d a Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund