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Home My WebLink About176792 09/02/2009 CITY OF CARMEL, INDIANA VENDOR: 143250 Page 1 of 1 ONE CIVIC SQUARE INAFSM CARMEL, INDIANA 46032 ATTN: UNIQUE DAHL CHECK AMOUNT: $195.00 f 115 W WASHINGTON ST SUITE 1368 S CHECK NUMBER: 176792 INDIANAPOLIS IN 46204 CHECK DATE: 9/2/2009 D EPARTMENT A CCOU NT PO N INVOICE NUMBER A DE 2200 4355300 30.00 ORGANIZATION MEMBER 2200 4357004 165.00 EXTERNAL INSTRUCT FEE t \oodP �ain and Sto,N, 2009 INAFSM Conference Q 3 Pokagon State Park, Angola, IN CD September 15 -18, 2009 0 INVOICE Rep,istrant Information August 20, 2009 John Thomas City of Carmel One Civic Square Carmel, Indiana 46032 Registration 2009 INAFSM Conference: John Thomas 140.00 2009 INAFSM Membership $30.00 Late fee $25.00 TOTAL AMOUNT OF PAYMENT 0 TOTAL AMOUNT DUE 195.00 Please forward payment to: INAFSM Attn: Unique Dahl 115 West Washington Street, Suite 1368 South Tower Indianapolis, IN 46204 Unique Dahl (317)536-6721, info a.inafsm.net "When submitting payment please enclose a copy of this invoice or a completed registration form with payment. �\O °dPiain and Srp�� INAFSM d 2009 ANNUAL CONFERENCE REGISTRATION MEMBERSHIP APPLICATION C September 15th -18th .cu j p 1 NAPS M Pokagon State Park, Angola, Indiana Send your registration to: By Mail: INAFSM- Attention Unique Dahl 115 W. Washington Street, Suite 1368 South Indianapolis, Indiana 46204 By Fax: (317) 632 -3306 MAKE CHECKS PAYABLE TO: INAFSM Website Address: www.inafsm.net REGISTRATION FEES Conference A. Member 140.00 (Sept. 16 -18` a. m.) B. Non Member 180.00 C. Student 30.00 Fee Based on Membership Status Optional: D. Integrating Natural Resource Pre and Post Conference Protection, Stormwater Management (8 -5pm) 80.00 Workshops E. CESSWI Certification Review Course (8 -5pm) 80.00 F. Building Public Support for (D -H held on Tue., Sept 15 Floodplain Management (8 -12pm) 40.00 G. Floodplain 101 (1 -4pm) No Charge H. Guidelines for the Hydrologic Hydraulic Assessment (14 held on Fri., Sept 18` of Floodplains in Indiana (1 -5pm) 40.00 I. Searching for Illicit Discharge Problems in the Field (1 -5pm) 40.00 For descriptions, see Agenda J. Updating your Multi- Hazard Mitigation Plan (1 -5pm) 40.00 *MEALS ARE NOT INCLUDED with items D- J K. Received On or Before July 31, 2009 0.00 Registration Deadline :KL. Received After July 31, 2009 25.00 Extra Opportunities M. Additional Guest for Wednesday Lunch 14.00 N. Additional Guest for Wednesday Dinner 15.00 0. Additional Guest for Thurs. Awards Luncheon 16.00 Vegetarian Meal P. Additional Guest for Thurs. Dinner $15.00 Diabetic Meal Please provide Guest Name for Name Badge INSERT THE APPLICABLE FEES AND ADD COLUMNS FOR TOTAL REGISTRATION FEES New Membership 0. 1 would like to become a NEW INAFSM member d 30.00 TOTAL AMOUNT OF PAYMENT Z 3 Name: !1 h v� Credentials (i.e., PE, CFM etc.) EMAIL r d/hG -S v� ��riLe ;/I, G'- Oy Phone: (317) -S J 2�0 /l Email is the primary form of contact for INAFSM!!! Fax: (3j7) 71 2q-7 Address: oy)e. v'r' City /State /Zip: L 1 Questions? Contact Unique Dahl at (3 17) 536 -6721, or admin @inafsm.net 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. f Payee INAFSM Purchase Order No. 115 W. Washington Street, Suite 1368 South Terms Indianapolis, IN 46204 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 08/20/09 n/a INAFSM Membership John Thomas $30.00 Valid thru 12/31108 109 INAFSM Conference john Thomas $1165.00 Total $195.00 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. INAFSM ALLOWED 20 115 W. Washington Street, Suite 1 368 Sol IN SUM OF Indi IN 46204 $195.00 ON ACCOUNT OF APPROPRIATION FOR nimprtmant of Fnginegriny Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or n/a n/a 2200- 4357004 $165.00 bill(s) is (are) true and correct and that the n/a n/a 2200- 4355300 $30.00 materials or services itemized thereon for which charge is made were ordered and received except 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund