178496 10/20/2009 a CITY OF CARMEL, INDIANA VENDOR: 00352485 Page 1 of 1
ONE CIVIC SQUARE JOHN P REDMOND FOUNDATION
CARMEL, INDIANA 46032 IAFF DEPT OF OCC. HEALTH SAFETY CHECK AMOUNT: $2,100.00
1750 NEW YORK AVE, NM CHECK NUMBER: 178496
t WASHINGTON DC 20006
CHECK DATE: 10/20/2009
DEPARTMENT A CCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4357004 2,100.00 EXTERNAL INSTRUCT FEE
2 0 .T H R E D: M O N D S Y M P O S I U RBI
Health Safety for the Professional Fire Fighter 11• -o
Hyatt Regency Century Plaza Los Angeles, CA
November 8 -12, 2009
Only one registrant per form. Each registrant must check off three workshops from Group A and a t
three workshops from Group B. Registrants selecting the Fire Ground Survival Practical Work-
shop will attend one from Group A and two from Group B or two from Group A and one from
Group B depending on which day they arc assigned to attend the Fire Ground Survival Practi-
cal Workshop. Attendance at the workshops is limited and will be determined on it t 11
first -come basis.
FIRE GROUND SURVIVAL PRACTICAL WORKSHOP
Tuesday or Wednesday
Space is limited and requires the registrant to bring their own personal protective equipment (turn -nut Coat and
pants, hood, gloves, boots and helmet). we will ONLY be able to accommodate 201 registrants on each day. t
Group A Workshops (C Beck "I lirre) Group B Workshops (Chc�k fhrc 1
0 WFI Implementation Fire Service Communication: Why t
Are Not Working
Q�Behavior ��ellness: Mental Aspects of They
Performance Fire Fighter Safety, Resource Deploy-
'C of Fire Fighter N•Vellness
merit and Staffing
❑Infectious Disease: How to Protect
Functional Fitness
Yourself Operating Safely: Protective Clothing
Fire Fighter Environment: Detection and Equipment Technology
and Dangers of'foxins in'l'oday's Fires l� ''ardiovascular Disease
El Building Codes :Making Buildings l'] Injury Prevention
Safer for Fire Fighters and Residents t
e•t• o
NAME
IAFF Local /Company Name
c-
Address V �U—o Q
City e���� State /Province
Zip cod e� y Phone
Email address
METHOD OF PAYMENT: $500 per registrant, $525 after September 30, 2009.
$500 1 will join the FIREPAC Leadership Trust and register for the John P. Red-
mond Symposium at the same tithe. I
PERSONAL CHECK /MONEY ORDER (Payable to FIREPAC)
PERSONAL VISAIMASTERCARD (complete credit card information below)
(Y] 5500 I will attend the Symposium but not join the FIREPAC Leadership Trust.
CHECK (Payable in U.S. Dollars to John P. Redmond Foundation)
VISA /rNIASTERCARD (complete credit card information below)
U.S. members only: FIREPAC can only accept personal checks, money orders or
personal credit cards. Federal election laws prohibit FIREPAC from accepting busi-
ness or union dues (treasury) account checks. Contributions to FIREPAC do not t
qualify as charitable contributions for federal income tax purposes.
FIREPAC Leadership Trust members will receive a Leadership Trust p and
recognition in the International Fire Fighter.
VISA /MASTERCARD
Credit Card Number
Name as it appears on the card 1
111.
Expiration date Signature 1
2 0 T H R E D tit O N D S Y M P O S I U. m
HealM Safety for the Professional Fire-Fighter
:Hyatt Regency Century Plaza Los Angeles, CA
November 8 -12, 2009
Only one registrant per form. Each registrant must check off three workshops from (Troup ,1 i t
and three workshops from Group B. Registrants selecting the Fire Ground Survival Practical
Workshop will attend one from Group A and two from Group B or two from Group A and one
from Group B depending on which day they are assigned to attend the Fire Ground Survival t
Practical Workshop. Attendance at the workshops is limited and will be determined on a
first -come basis. t r. I a
FIRE GROUND SURVIVAL PRACTICAL WORKSHOP t I
Tuesday or Wednesday
Space is limited and requires the registrant to bring their own personal protective equipment (turn -out coat .Ind =09 it
pants, hood, gloves. boots and helmet). We will ONLY be able to accummodate 200 registrants on each d.n' u i
Group A Workshops wheck'lhree) Grout) B Workshops'LhecL I hrk :49641-046
%VFI Implementation Fire Service Communication: Why u I
l s havior Wellness: Mental Aspects of They Are Not 1Vorking I
Performance Fire Fighter Safety, Resource
(Economics of Fire Fighter Wellness Deployment and Staffing
Infectious Disease: How to Protect 6 4"1][0)
Fitness
Yourself C3 Operating Safely: Protective Clothing i
and Equipment Technology
ire Fighter Environment: Detection I
and Dangers of Toxins in Today's Fires DidCordiovasculor Disease i
Building Codes :Making Buildings f (ljury Prevention
Safer for Fire Fighters and Residents
IAFF Local /Company Nanc CNN- Lt'—
Address
City CSC oo'e 1 State /Province N t I
Z
Zip Code Phone 6 -0
Email address Y\%Ke_� f rti e. +'rte 4t) J
I
METHOD OF PAYMENT: 5500 per -registrant; $525 after September 30, 2009.
$500 1 will join the FIREPAC Leadership Trust and register for the John P.
Redmond Symposium at the same time. I
PERSONAL CHECK /MONEY ORDER (Payable to FIREPAC)
PERSONAL VISA/NIASTE•RCARD (complete credit card information below)
O 4500 1 will attend the Symposium but not join the FIR.EPAC Leadership Trust. CHECK (Payable in U.S. Dollars to John P. Redmond Foundation)
VISAJINIASTERCARD (complete credit card information below)
U.S. members only: FIREPAC can only accept personal checks, money orders or
personal credit cards. Federal election laws pruhibit FIREPAC fruut accepting; busi- :A
ness or union dues (treasury) account checks. Contributions to FIREPAC do not
qualify as charitable contributions for federal income tax purposes. «t
FIREPAC Leadership Trust members will receive a Leadership Trust pin and
recognition in the International Fire Fighter.
VISA/MASTERCARD
Credit Card Number
Nance as it appears on the card
Expiration date Signature
rr off
I
2. O T H R E D M O N D S Y PSI P O S. I U P;1
Health Safety for the Professional Fire Fighter
Hyatt Century Plaza Los Angeles, CA
November 8 -12, 2009
Only 6ne registrant per form. Each registrant must check oft three workshops from Group A •ti I I
and three workshops from Group D. Registrants selecting the Fire Ground Survival Practical
Workshop will attend one from Group A and two from Group B or two from Group A and one
from Group B depending on which day they are assigned to attend the Fire Ground Survival
Practical Workshop. Attendance at the wurk::hups is limited and will be determined on a I t
first iUI]le basis,
FIRE GROUND SURVIVAL. PRACTICAL WORKSHOP I
Tuesday or Wednesday
spat, is limited and requires the registr.im to tiring their own perxmal protective equipment (turn -out colt n,l r
pants, hood, gloves, ho is and hclntct). Nc will ONLY be able to accommodate 200 registrants on each d,le. r• u i
Group A Workshops fCheck't hrec} Gr Urn B Workshops ('h _c: Lt re ..r�
U( Implementation Fire Service Communication: Why
/Pehavior Wellness: Mental Aspects of Z7
Are Not Working
i t•
erformance Fire Fighter Safety, Resource
a Economics of Fire Fighter �`talness eploynient and Staffing
O Infectious Disease: How to Protect
2unctional Fitness
Yourself Operating Safely: Protective Clothing r oil if
Fire Fibhter Environment: Detection nd Equipment Technolog}
and Dangers of Toxins in Today's Fires 71-.jury ardiovascular Disease
Q Building Codes :lMaking Buildings Prevention y
Safer For Fire Fighters and Residents I I
NA]4IE
IAFF Local /Company Namr
Address
State /Province 0- 1 t o•
Ctty
••Lf
Zip
Email address c�co�� �a r��� I 1
METRO_ D OF PAYMENT: $300 per registrant; -$525 after September 30,2009.
`C] $5Q0 I will join the FIREPAC Leadership Trust and register for the John P.
Redmond Symposium at the same time. o I t
PERSONAL CHECK/MONEY ORDER (Payable to FIREPAC)
PERSONAL VISA/NiASTERCARD (complete credit card information below)
l►d 500 1 will attend the Symposium but not join the FIREPAC Leadership Trust.
Cl CHECK (Payable in U.S. Dollars to lohn P. Redmond Foundation)
O VISA /NIASTERCARD (complete credit card information below)
U.S. members only: FIREPAC can only accept personal checks, monev orders or
petsonal credit cards. Federal eleuiuu laws ptuhibit FIREPAC ftuttt accepting busi
ness or union dues (treasury) account checks. Contributions to FIREPAC do not
qualify as charitable eontrihutions for federal income tax pttrpos�;, t
FIREPAC Leadership Trust members ]will receive a Leadership Trust pin and
recognition in the International Fire Fighter.
VISA/MASTERCARD
Credit Card Number
Naive as it appears on the card
Expiration date Signature
I
2 0 T H R E D M O N D S Y M P O S I U M
Health Safety for the Professional Fire Fighter 11•
Hyatt Regency Century Plaza Lo's- Angeles, CA
November 8 -12, 2009
Only one registrant per form. Each registrant must check off three workshops from Group A and F N I
three workshops from Group H, Registrants selecting the Fire Ground Survival Practical Work-
shop will attend one from Group A and two from Group B or two from Group A and one from
Group B depending on which day they are assigned to attend the Fire Ground Survival Practi-
cal Workshop. Attendance at the workshops is limited and will be determined on a t 11
first -come basis.
FIRE GROUND SURVIVAL PRACTICAL WORKSHOP
Tuesday or` Wednesday
Space is limited and requires the registrant to bring their own personal protective equipment (turn -out tout and
pants, hood, gloves, boots and helmet). We will ONLY b,• able to accommodate 200 registrants on each ik iv.
Group A Workshops (Check "I hrre) Group B Workshops (C licck I hr cc', 1
U 4VF1 Implementation :1 Fire Service Communication: Why t
f/ 3chavior Wellness: Mental Aspects of They Are Not �Vurking
Performance Fire Fighter Safctv, Resource Deploy
a Economics of Fire Fighter Wellness ment and Staffing
Infectious Disease: How to Protect Functional Fitness
Yourself Operating Safely: Protective Clothing
Fire Fighter Environment: Detection and Equipment Technology
and Dangers of Toxins in Today's Fires Yinjury (ardiovascular Disease
C3 Building Codes :Making Buildings Prevention
Safer for Fire Fighters and Residents
NAME J r
IAFF Local /Company Name
Address
State /Prolrince
Zip Code y `°o Phone
Email address ��L tC� `�b c 1 1 o
METHOD OF PAYMENT: 5500 per registrant; $525 after September 30, 2009.
Cl $500 .I will join the FIREPAC Leadership Trust.and register for the John P. Reel
Mond Symposium at the same time.
PERSONAL CHECK/MONEY ORDER (Payable to FIREPAC)
PERSONAL VISA/MASTERCARD (complete credit card information below)
Ld $500 I will attend the Symposium but not join the FIREPAC Leadership Trust.
CHECK (Payable in U.S. Dollars to John P. Redmond Foundation)
VISA/MASTERCARD (complete credit card information below)
U.S. members only: FIREPAC can only accept personal checks, money orders or
personal credit cards. Federal election laws prohibit FIREPAC from accepting busi-
ness or union dues (treasury) account Contributions to FIREPAC do not a t 0
qualify as charitable contributions for federal income ta_v purposes.
FIREPAC Leadership Trust members will receive a Leadership Trust pin and
recognition in the Intemational Fire Fighter.
VISA /MASTERCARD
Credit Card Number
Name as it appears on the card 1
1 111.
Expiration date Signature
Prescrit;ed 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))
Total o Q_
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
IN SUM OF
"Z�, cz,
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Q 0
r
a
Signature
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund