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HomeMy WebLinkAbout208843 05/10/2012 CITY OF CARMEL, INDIANA VENDOR: 358681 Page 1 of 1 ONE CIVIC SQUARE PURDUE UNIVERSITY -CEC BUSINESS O GHECK AMOUNT: $70.00 CARMEL, INDIANA 46032 STEWART CENTER, ROOM 110 a 128 MEMORIAL MALL CHECK NUMBER: 208843 WEST LAFAYETTE IN 47907 -1586 CHECK DATE: 5/10/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4357004 70.00 EXTERNAL INSTRUCT FEE Registration Form EV -1zFY Regasftaa4Aoaa Daafformaa$uoea Payment is required upon submission of registration. Acceptable 1 Pavem nt Mana ement Workshop forms of payment are a hard copy of a purchase order, check, or Name /�lt�= f��� /oS A credit card. The registration deadline for the May workshops is May 18; the deadline for the June workshops is June 15. Refunds Title �u�G.b9 for cancellations will not be given after those deadlines. Purdue Agency tl'a i141-'/ S�6'�°L°� ('627 University is not responsible for costs due to cancellation. Address ©,2 kt') 13 Price of the workshop includes a lunch to be served at the hotel. City tfar44''1 State -ELI zip For questions regarding registration, billing, and payment, Wo Phone .3/ 7 7.33 07,00 1 contact Emily Warter, Conference Coordinator, at (765) 494 Fax f 7j a�ov or by email at ewarter@purdue.edu. For additional program information, contact Rich Domonkos, Training Specialist, Indiana E -mail �/�Ir�b6S V e T h G d rr f�Per LTAP, at (800) 428 7639, or (765) 494 2i64• 64Vl0ie -,C714 4�w To register online, visit www.conf.purdue.edu /INLTAP or visit Purdue is committed to making its programs accessible to individuals with the Indiana LTAP website training calendar at www.purdue.edu/ disabilities. If you require an accommodation or special assistance for this initap and click "register" next to the event. program, due to a disability, please contact us at (765) 494 -21 64 at least one week before the program begins. L eec $¢�a ®8¢aa' @Iraffolrlro>1ae�llaDaa Registration vement Management Workshop meets the requirements re Course. #1: Powers and Duties of a Local Agency Please check one rate: ortation Official. This workshop will also be considered an Government ($35) C1 Non-Government ($1oo) 13 Exhibitor Booths ($225) in the program and is worth six (6) Road Scholar credits. Please check one location: ates of Attendance will be available for pick -up on the day ❑Vincennes (1058412FY) []Clarksville (1058512FY) ❑Muncie (1058612FY) workshop and should be kept with your Road Scholar files C'Lafayette (1o5871zFY) ❑Fort Wayne (105881zFY) ❑Portage (1058912FY) y your attendance. Certificates not picked up by attendees be forwarded once the workshop has ended. Payment Method (Payment is due upon submission of registration) (Continuing Education Units/ Enclosed is a check made payable to Purdue University l rolessionaa0 Deeegop pent Hours am paying with a Purchase Order Continuing Education Units (CEU) are a standardized, nationwide method of recognizing and rewarding participation in non- P.O. credit educational activities. Participants will receive 6 PDH /o.6 Bill to: C I rf1 CEU for the day. These are granted through Purdue Extended Company Organlization//\\ Campus. Forms will be available at the workshop. PDH /CEU will Address l3 �I�Q be available to licensed engineers. In order to receive full credit for the day, participants must check in at the registration desk at City -_m tL State ZIP (D the beginning of the day, and complete a CEU request form at the Please charge to my: end of training. Requests for CEU will not be accepted after the session date. MasterCard VISA Discover American Express Exhiibitoir [Information AccountNumber Vendor booth rates are $225. This fee includes one six -foot table Expiration Date and two chairs for the day. This fee also includes registration for one representative from your agency. Additional representatives Printed Name should register separately. Signature Booth set -up will be available beginning at 7:oo a.m. You will not Fax with credit card or P.O. information to: (765) 494 0567 be able to set up the night before. Booths will be assigned on a Mail with payment to: PEC Business Office first -come, first served basis. Purdue Universit Stewart Center Room 110 128 Memorial Mall Pnrrluo Ilnivorci is nn on,inl nr,- occ /onnn n u r l nnnnrtnity nivocity_ 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)) 04/26/12 $70.00 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 1 VOUCHER N WARRANT NO. ALLOWED 20 Purdue University CEC Business Office IN SUM OF Stewart Center, Room 110, 128 Memorial Mall West Lafayette, IN 47907 -1586 $70.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 2201 I I 43- 570.041 $70.00 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 b Wednesday�May 02, 2012 1 '0 f-I k.) w4l If Street Commissioner 3 eel 'v� ale Issioner Cost distribution ledger classification if claim paid motor vehicle highway fund