179728 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 163900 Page 1 of 1
ONE CIVIC SQUARE INTERNATL ASSOC OF FIRE CHIEFS CHECK AMOUNT: $229.00
CARMEL, INDIANA 46032 PO BOX 75649
BALTIMORE MD 21275
CHECK NUMBER: 179728
CHECK DATE: 11/24/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUN DESCRIPTION
1120 4355300 229.00 ORGANIZATION MEMBER
r
APPLICATION
By Fax: 703/273 -9363 By Phone: 866/385 -9110
Online: www.iafc.org/join, enter 09WEB By Mail: PO Box 75649
under source code on the application Baltimore, MD 21275 -5649
PAYMENT METHOD
Name
Check (payable to IAFC, in U.S. dollars)
Titl Charge to: American Express MasterCard Visa
pa-y Card num er
Address Expiration date
City State Zip Country Name on car
Is this address: Home /Department
Signature
P one TO HELP US SERVE YOU BETTER, PLEASE ANSWER
THE FOLLOWING QUESTIONS
Fax
Department Type Population Served
I(Career 0 -9,999
E -mai
Combination El 0,000- 49,999
)I
V50"000-99,999
5
MBERSHIP CHOICES (select one) Federal /Military (see branch below) 0,000- 99,999
Regular member (Fire Chief, Fire Marshal, Chief Officers, Industrial 100,000- 199,999
2 -5 crossed bugles) Volunteer 200,000 and up
Departmental member (population served is 10,000 or less; Other
all department employees are eligible for discounted member rate)
Federal /Military Branch
Associate member (Elected or appointed officials, individuals representing
businesses which are interested in the IAFC, and other interested parties.) El Air Force Coast Guard ❑Navy
Army El Defense Logistics Veterans Affairs
IAFC DUES (select one) Bureau of Land Management Marine Corps
Canadian (Eligible only if CAFC member) $252.00
❑Eastern (DC, DE, MD, NJ, NY, PA) $229.00 Please check all topics of interest
Ir0 J Great Lakes (IL, IN, MI, MN, OH, WI) $229.00 Emergency Vehicle FireFighter Safety Military
International (Outside U.S. and Canadian Division —non CAFC) $242.00 Management Fire Prevention Officer Development
Missouri Valley (CO, IA, KS, MO, NE, ND, SD, WY) $229.00 Budget Management Fitness /Wellness Risk Management
New England (CT, ME, MA, NH, RI, VT) $234.00 Building Codes Govt. Relations Technology
Southeastern (AL, FL, GA, KY, MS, NC, SC, TN,VA, WV, Career /Volunteer/ Grants /Fundraising Terrorism /Homeland
Puerto Rico and Virgin Islands) I...... $239.00 Combination Issues Hazmat Security
Southwestern (AR, LA, NM, OK, TX) $234.00 Community El Human Resources i g
k
/M
i
latons aretng Training/Education
/Education
El Western (AK, AZ, CA, HI, ID, MT, NV, OR, UT, WA, Re Wildland Fire
and Pacific Territories) $274.00 Conflict Management Industrial Fire and
Safety ❑Other
Disaster Management Labor/ Management
SECTION DUES (Optional, join any or all sections when you Diversity/Recruitment Relations
become an IAFC member) EMS
Emergency Vehicle Management $25.00
EMS $25.00 Your response to the following is optional. The data will be used for statistical
Federal and Military Fire Service $20.00 purposes only.
Fire and Life Safety $25.00 Sex Male Female
Industrial Fire and Safety $25.00 Race African American Caucasian Native American
Safety, Health and Survival $25.00 Asian /Pacific Islander Hispanic Other
Volunteer Combination Officers $25.00
Year of Birth (YYYY)
IAFC DUES (in U.S. dollars)
SECTION DUES (in U.S. dollars) Were you referred by an IAFC member?
Donate to IAFC Foundation Scholarships
M ember s Name
$10 $15 $20 $25 other
'S 1 of your annual membership dues will be allocated coward a one year subscription to Fm Rerme Magazine,
which is non deductible from your dues.
TOTAL (in U.S. dollars)* As of Oct 09
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))
Haboush $229.00
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
"AFC In
r IN SUM OF
P.O. Box 75649
Baltimore, MD 21275
$229.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 43- 553.00 $229.00 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
NOV 2 3 mag
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund