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Home My WebLink About208471 04/25/2012 CITY OF CARMEL, INDIANA VENDOR: 366188 Page 1 of 1 ONE CIVIC SQUARE ST PAUL RIVERFRONT CARMEL, INDIANA 46032 11 EAST KELLOGG BLVD CHECK AMOUNT: $687.45 •r <roa b ST PAUL MN 55101 CHECK NUMBER: 208471 CHECK DATE: 4125/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4343002 687.45 EXTERNAL TRAINING TRA INVOICE Date: April 19, 2012 Sold to: City of Carmel Police Department 3 Civic Square Carmel, IN 46032 Payment for lodging for Mike Pitman on April 27 May 2, 2012 in St. Paul, MN Confirmation 964740009 Room Rate Tax Total $121.00 $16.49 $137.49 x 5 $687.45 TOTAL DUE: $687.45 Please make check payable to: St. Paul Riverfront 11 East Kellogg Boulevard St. Paul, MN 55101 1 22 Annual IPM conference St. Paul, Minnesota April 28 -May 5, 2012 Registration Form Page 1 of 2 lease read "Registration Checklist" on back of workshop descriptions before filling out this tease check all boxes that apply and add registration form. PRINT LEGIBLY. P up the right column for your total. You To avoid rush fee, registration forms must be received by March 24 2012 can register for just the pre conference, just Name (As you wouYd like it to appear on your nomelag, and in all correspondence) the conference, or, ideally, both! M= 210 1 11 I oa�aaoao�000ao 00000❑ p N You must be a current member to attend any of the pre conference Fnt teen training courses Join or renew below if you are not currently a member, Home Address Bicycle Response Team Training $375 Sri Qt'r1 5 6"Ik r EMS Cyclist Course $325 n Street Address IPMBA Instructor Course $550 city s"'. oatei Code country IPMBA Instructor Application ancOsod ,$•1255 p 3 J ❑Nome You must Personal Telephon T v `1 it apply and be approved to attend Contact the IPMBA office with questions Maintenance Officer Certification Course 0($525 E -Mail /7] B r�111 9 f rim I`be O f MMR -IPMBA Core Skills Scenarios Clinic. $495 (Co rmetrona nbe sent 'I. er! TM Il sf)tW m.l Dept. Name �}R M E ��,E_ Police Cyclist Course $325 A, rt will eypeer °n mefeg) e Dept. Address (�;I J t C trE str.e�Addre 777 IPMBA Member Fee C) $400 T N LAO O �jo�� MUST be current, you muss provide your current IPMBA membershi w J number on this form a prntenew with this registration �dy S 1i P° 1otle D Non -IPMBA Member Fee $475 Dept. Telephone 3/ -St�O Fee for Pre Conference Attendees $350 If IPMBA Membership Number D T v c urs are ourses it "s is thg f ee the to als at h to ng c is is thee you pay to also adend t wn(erence IMO otoryl°rCWlenlondrenew embers Bike Team Rate IPMBA Instructor Number V Cr det ails Cl $350 See box in fell column for details Tee Shirt Size ❑M ❑L 03XL ❑XXL ❑XXXL (yw .41 ro w- a LARGE d you don Y check ...If Guest Fee (per guest) Guests x $50 The guest fee enblles your guest admission to the exhibit hall and two lunches NAME(s) Lunches are Included In the cost of each pre conference course During the Rush Fee L) 25 Rogistrat conference, lunches will be served on Thursday and Friday, please check the tInc te r Registrations submitted after March 21, 1012, Mus Inc lude the rush fee appropriate boxes on the reverse All other meals are on your own Exhibit Hall -Only Pass (Pre Registration Roquued) Free M n TIM Register three or more members from the same agency at a fiat rate of New O Renew 50 $350 per team memberl The following conditions apply Applies to CONFERENCE fees only Does NOT apply to Pre- Conference Course Fees TOTAL ENCLOSED J J, Can be used by both conference -only attendees and those attending both a CANCELLATION POLICY Refund requests must be made in writing and postmarked by pre conference course and the conference Marc, 24, 2012 Refunds, less a $50 adnrnlstrabon fee, will be processed following the conference No refunds after March 24 tf you must cancel after March 24, you may locale a Registrants MUST be IPMBA members (current, joining, or renewing) substitute and submit h!s/herregistration form and a letterreauestrng the transfer of fees Registrations MUST be submitted together (offer not available online) Membership, certification, and instructor application fees are non- refundatAe IF YOU ARE REGISTERING FOR THE CONFERENCE, HAVE YOU COMPLETED PAGE 2 OF THIS FORM? 1 Form of Payment [MUST ACCOMPANY REGISTRATION] Purchase Order number Check or money order (payable to IPMBA) enclosed or departmental equivalent Visa /MasterCard accepted (circle one) Dewtment to which the In— shovld De sent Expire Signature A Name on card Address Email address for receipt eau suite Zia Contact phone Plan. Police on Biker Inc dba International Pahce Afwmtain Dike Abucmuon i kedeml l D Number .i2- 1137:81 W12 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)) 04/19/12 lodging for Det. Pitman $687.45 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. ALLOWED 20 St. Paul Riverfront IN SUM OF 11 East Kellogg Boulevard St. Paul, MN 55101 $687.45 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1110 43- 430.02 $687.45 I hereby certify that the attached invoice(s), or I 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 Thursday, April 19, 2012 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund