211125 07/19/2012 CITY OF CARMEL, INDIANA VENDOR: 143001 Page 1 of 1
:. ONE CIVIC SQUARE INDIANA ASSOC OF CITIES&TOWNS
0
CARMEL, INDIANA 46032 CONFERENCE REGISTRATION CHECK AMOUNT: $95.00
200 S MERIDIAN ST,SUITE 340 CHECK NUMBER: 211125
INDIANAPOLIS IN 46225
CHECK DATE: 7/19/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4357004 95 . 00 EXTERNAL INSTRUCT FEE
2 012 IACT Leadership Conference Registration Form
PRE-REGISTRATION DEADLINE IS WEDNESDAY, AUGUST 1 .
Your Information Method of Payment
Name ` � �^ (Circle One) Check MasterCard Visa Discover
Preferred Name for Badge Check Num
City/Company Card Number
Title y Expiration Date
Address /%, ,qt . Three-digit Security Code
City/Town ��p , Name of Cardholder
State �< � � Authorized Signature
Zip 2 Billing Address(if different from above)
Phone
Email City
y 1A
�`��C
Name of Spouse/Guest(if attending) State
Special Needs and Dietary Restrictions Zip
Hotel Information
French Lick Resort
8670 West State Road 56
French Lick, Indiana 47432
Re Otration Fees (Please check all that apply) (888)936-9360
V,K5.00 Member Hotel Cutoff Date: Friday,July 20
❑$120.00-IACT Member(Late-After August 1)
❑$85.00-Spouse/Guest Please contact the hotel directly to make your reservation and use
group code 08121AC. Reservations must be made by July 20 to
❑$110.00•Spouse/Guest(Late-After August i) receive the special IACT rate of$129.00 per night. Only registered
❑$0 sponsor participants may occupy a room with the IACT block. IACT is not
1- ee responsible for hotel reservations or cancellations. Hotel check-in is
Total S 4:00 p.m.and check-out is 11:00 a.m.
Two Easy Ways to Register
Mail registration form with payment to IACT at 200 S. Meridian St., Ste. 340, Indianapolis, IN 46225
Fax registration form with payment to 317-237-6206
Late & ®nsite Registration
The pre-registration deadline is August 1. Registrations received after August 1 will be treated as onsite registrations and require and ad-
ditional charge of$25.
Spouse/Guest Registration
The spouse/guest registration fee is restricted to those who are not municipal officials and who have no professional interest at the confer-
ence. The fee includes all conference meals.
Cancellation Policy
Your registration is considered your commitment to attend. Unless attendees follow the cancellation policy, no-shows will be billed. Refunds
will be made only if IACT is notified of cancellation in writing on or before August 1 by fax, mail or email to kstorms@citiesandtowns.org.
Special Needs
IACT will make all programs accessible to you. If you require special arrangements, or a special diet, please notify IACT on your registration
form. We may not be able to accommodate such requests made on the day of the program.
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.
Payee
IV Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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.
I ALLOWED 20
I IN SUM OF $
�11Cr�IS (Ii
ON ACCOUNT OF APPROPRIATION FOR
rt ���
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
'J��LOD S 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
.� 0
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund