180124 12/08/2009 CITY OF CARMEL, INDIANA VENDOR: 363642 Page 1 of 1
Q� ONE CIVIC SQUARE I A F F CHECK AMOUNT: $375.00
®.i CARMEL, INDIANA 46032 ATTN: EDUCATION DEPT
1750 NEW YORK AVE NW CHECK NUMBER: 180124
WASHINGTON DC 20006
CHECK DATE: 12/8/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4357004 375.00 EXTERNAL INSTRUCT FEE
Registration Information Participants who choose the fax or mail option must complete the
registration form and have their local president sign it. A separate
INSTRUCTIONS: registration form must be completed for each participant.
The Ernest A. "Buddy" Mass Human Relations (HR) Conference Once registered, the IAFF will send you a confirmation letter and
and the Affiliate Leadership Training Summit (ALTS) will be held your workshop schedule.
back -to -back at the Buena.Vista Palace Hotel. If mailing or faxing a registration form, make sure to provide an
Affiliate leaders can register for: e -mail address for receiving your registration confirmation.
The HR Conference (January 24 -27, 2010) at $375 per person You may cancel your registration until December 24, 2009, for a
OR full refund. Requests must be made in writing and sent to:
The ALTS Conference (January 27-29,2010) at $425 per IAFF, Attn: Department of Education, 1750 New York Avenue,
person. Optional pre- conference events include Fire Ops 101 NW, Washington, DC 20006 or fax to (202) 737 -8418.
(Train- the Trainer) January 26 (add $40) or the New Leadership
Seminar January 27 (add $40). See ALTS brochure for more details.
OR FIREPAC Contribution:
The HR and ALTS Conferences combined (January 24 -29,
2010) at a discounted rate of $650 (save $150). FIREPAC contributions made before January 1, 2010, will be
*PLEASE NOTE: to register for both conferences and receive the applied to the member's 2009 contribution totals.
discount, you must complete and mail or fax both conference
registration forms with one payment of $650. You cannot IAFF members can make a FIREPAC contribution and register
register online for both everts. for the Human Relations Conference, in tone step. This FIREPAC
option is available only to IAFF members. United States federal
Mail to: IAFF election law prohibits the solicitation of non -IAFF members.
Attn: Department of Education U.S. IAFF members selecting the FIREPAC option must
1750 New York Avenue, NW submit their own personal check or credit card. Federal
Washington, DC 20006 election law prohibits FIREPAC from accepting union or cor-
porate money. One person cannot write a personal check or use
Or fax to: (202) 737 -8418 a personal credit card to cover multiple registrants contributing
to FIREPAC. Canadian IAFF members selecting the FIREPAC
You must have approval from your affiliate president to attend this event. option may submit a check or money order. Please note that
contributions to FIREPAC are not tax deductible. Previous
Three ways to register: FIREPAC contributions and monthly FIREPAC Check -Off
deductions cannot.be applied toward registration.
Online: www.iaff.org/hr /conference (Visa or MasterCard only)
Fax: (202) 737 -8418, Attn: Education Department (Visa or There are three options for making FIREPAC contributions:
MasterCard only)
Mail: Send the registration form with payment to: IAFF, Attn: 1, FIREPAC Leadership Trust
Education Department, 1750 New York Avenue, NW, Register for both Human Relations Conference.and Affiliate
Washington DC 20006 Leadership Training Summit.
IAFF members making a personal, voluntary contribution of
$650 or more to FIREPAC will be enrolled in the FIREPAC
Hotel and Travel lnforMatlon
v wow s Leadership Trust and registered for both conferences —Human
The Buena Visia Palace Hotel checked bag. The carry -on policy Relations and ALTS. Registrants using this FIREPAC option will
1900 Buena Vista D `rive. ,a,.: of one personal item (such as j receive a Leadership Trust pin and recognition in the
Lake:Buena Vista FL,32830� purse or laptop bag) plus one bag International Fire Fighter. Registration must be submitted by
(866)397 65,16 �remams mail or fax.
r
2. FIREPAC :Leadership Trust
The Buena Vista Palace Hotel is the �l Rental Cars x
K headquarters for Human Avis is the official rental car'
ar yr Register for the Human Relations Conference
Relations ,Conference: The hotel is company of the 2010 Hurriar
convementl ,located across the a {Relations Conference To make IAFF members making a personal voluntary contribution of $500
Y m or more to FIREPAC will be enrolled in the FIREPAC Leadershi
street from Downtown Disney and your reservations, contact Avis P
20 minutes from d'own6wn R nt...Car.at (800)'331 1600'and Trust and registered for the Human Relations Conference.
Orlando,aiid Orlando provide the discount code J09 Registrants using this FIREPAC option will receive a Leadership
International Airport r
Trust pin and recognition in the International Fire Fighter.
Ground Transportation av' Registration may be submitted online, by mail or by fax.
Flights Mears Transportation offers
The IAFF has arranged discounts discotmted ground transportation 3. FIREPAC Founder's Circle
on airfare from American Airlmes Between Orlando International Register for the Human Relations Conference
E„ Call Aican Airlines:at
mer (800) s Airport (MCO) and the Bu na
433 -1790 or book your Vista Palace Hotel (discount' 'does IAFF members who make a voluntary $375 contribution to
online at www.aa i and provide' "not apply the Orlando`Sar ford FIREPAC will join the FIREPAC Founders Circle and be regis
Ahe discount code number, 4 Internauorial Airport (SFB)): To tered f or the Human Relations Conference. Registrants using
3510AD save $4 off the regular roundi rip this FIREPAC option will receive a Founders Circle pin and
price make a reservationonline at recognition in the International Fire Fighter. Registration may
*PLEASENOTE Customers who wvwmearsiransportation.com i be s online, by mail or by fax.
purchase dome'suc economy class click on Shuttles in'the `Make a
will be charged $20 each tReserva66n' NOWT box and enter PLEASE NOTE: NO FIREPAC DONATIONS CAN BE MADE
tickets
way, for the fifst checked`bag'andf ti e priority code number .BY CREDIT .CARD IF-YOU ARE.AN„IAFF, MEMBER IN
$30 each way'for the second 360505517; "or call° 800)15
CANADA.
.F _.",w
CLASS SELECTION:
From the list of sessions provided, choose six workshops to attend.
Title: Mr. Mrs. Ms. Dr. Other c Write the name of each workshop on the lines below.
IAFF Membership Number: Q (Note: Space is limited and sessions will be filled on a first -come basis.
h IA If you do not complete this section, you will be randomly assigned to
Email Address: L P IA Ci(I��m e f v available sessions.)
First Name: Class Choices:
Last Name: Ov► 5' r 1 l
J �J J J 1 S
Preferred Name for Badge:
Street Address: oL C of 5�1 2.
City: State /Province: �'N Zip 3
3. G~o c s P a 64 3
Country: U 5. Phone Number. 3O 6 -4 1 I a
My current affiliate office is: 4.
President Vice President O Secretary- Treasurer 5.
Secretary Treasurer Executive Board Member
Steward ❑Human Relations Committee ❑None 6. S�� "�'t..�5 (I
6rbther �dM:ti f ,0- Altern eJ i 0 Pi�wCJ( fr�^`/�' LC "✓Y
Alternate Choices:
APPROVAL: 1 U CfeSS y
Local Number Lo Name: C w ✓tom I YL
G
President's Signature: 2.
PAYMENT IN FORMAT
ION r„
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w t, ihl4sf:.a:1"
Please choose one of the,five registration options for coferences optional eventsand payment U SsIAFFm "embers selecting the FIREPAC option mus subm
t'it,
pe pe or
use'ar s credit' "card to cover muftlple regsVants`contnbuting:to.
their own rsonal check o'r +credltcaid�' Onei rson cannot�wnte� rsonal�chei ck�;
yktpe�sonal
"FIREPAC. }Canadian IAFF members selectmglthe „FIREPAwC opUori, may subumit-a check7or, moneyrorder ;See, the „FIREPAC "Contnbutlon sectlori fog fuittier+
n ,4 „h4h it F a �W 4 4 w Pi s ifiFd
x 4r
I 1St 1UCtI0nS
w i a'.a: JIU��'i:�a'.- .v.: li�d..e,� !ts- rp'�''r!1u.a�. ic�.l 'HI r lw. �:Itl� �d '.e,;.r�+:5r 3 -i-a _�..r.>••.+w,.n u asi u>»..n: r t:,n,'n�.�°'„�' "�:as''
FIREPAC O dons NON`FIREPAC Options,
OPTION 1: OPTION 1:
FIREPAC Leadership Trust Human Relations Conference and Human Relations Conference and
Affiliate Leadership Training Summit ($650) Affiliate Leadership Training Summit ($650)
Check the optional event(s) you will attend: Check the optional event(s) you will attend:
Fire Ops 101 (Train- the Trainer) 1/26/10 (add $40) Fire Ops 101 (Train- the Trainer) 1/26/10 (add $40)
New Leadership Seminar 1/27/10 (add $40) New Leadership Seminar 1/27/10 (add $40)
OPTION 2: P T
FIREPAC Leadership Trust Human Relations Conference ($500) HB' uman Relations Conference ($375)
OPTION 3: PAYMENT for. NON- FIREPAC'OPTIONS a
El FIREPAC Founder's Circle Human Relations Conference ($375) Cfieck or Money,Order Make payable to IAFF'°
Personal or Corporate Credit Card
P x w Visa MasterCard r
PAC OPTIONS ,tlyu,
1 w'
PAYMENT for FIRE
Personal .Check or' Money Order U.S. Members
Make your'check payable to IAFF FIREPAC
Personal Check "or,Money, Order Canadian Members a ur
Make your check or.money order payable to IAFF FIREPAC Canada
O Personal Credd Card (U S members only) t
0 Visa ❑MasterCarde
r r� t. „�"""^.s PR�"""� I i lar
en,re Ise both the' Human Relations Conference and ALTS youlmust mail or.fax bdtK. registration f orm h one paymen
Wh s wdt of
$650 You.
"cannot re ster onl ne "otfi events: For uestons Terdln re ration, contact the AFF Department of: Educa#ionat`(202) 824 ;1533;
y s
....'ni ,g 'q9r ag r, gr 'iv�llg' ist
If paying by credit card, please complete the information below:
PLEASE NOTE: NO FIREPAC DONATIONS CAN BE MADE BY CREDIT CARD IF _YOU ARE AN IAFF`MEMBER IN CANADA.
Type of Credit Card: Visa MasterCard Payment Amount:
S.
Name on Credit Card: t
i
Credit Card Number: Expiration Date: i
't
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))
$375.00
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 NO.
ALLOWED 20
IAFF
IN SUM OF
Department of Education
1750 New York Avenue NW
Washington, DC 20006
$375.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 43- 570.04 $375.00 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
r�
I
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund