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Home My WebLink About212640 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 155400 Page 1 of 1 ONE CIVIC SQUARE INDIANA STATE BAR ASSOC ?o CARMEL, INDIANA 46032 ONE INDIANA SQUARE,SUITE 530 CHECK AMOUNT: $105.00 M<..aF'co INDIANAPOLIS IN 46204-2199 CHECK NUMBER: 212640 CHECK DATE: 9/12/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1180 4355300 105 . 00 ORGANIZATION & MEMBER APPLICATION FOR MEMBERSHIP IN THE INDIANA STATE BAR ASSOCIATION I hereby make application for MEMBERSHIP in the Indiana State Bar Association and certify that I am a member of the legal profession in good standing.I was admitted to practice before the Supreme Court of Indiana on ' Not being admitted in Indiana,I am applying for Non-Resident or Associate Membership.I was admitted to practice in on and am a member of the Bar of said jurisdiction in good standing. mmiaain'y \ 1 (si t e of applicant la ATer) BE CERTAIN TO COMPLETE THE OPPOSITE SIA4 THIS FORM! Return To: Return this portion of your application with your Indiana State Bar Association check payable to ISBA. If paying by credit card, One Indiana Square,Suite 530 please provide us with the necessary information: Indianapolis,IN 46204 ❑ Visa ❑ Mastercard ❑ Discover Fax:317-266-2588;E-mail: isbaadmin @inbar.org Visit our website for additional information, Card# wwminbanorg. Exp. Date Verification Code Signature Separate at above perforation.Submit top section only. ANNUAL DUES (Fiscal year begins July 1) Resident Member,admitted to practice more than 6 years...... Resident Member,admitted 3 to 6 years,inclusive.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .$140.00 Resident Member,admitted less than 3 years.. ..$ 65.00 Resident Associate Member.. .. .. .. .. .. .. .. .. .. $230.00 Non-Resident Member.. ...$125.00 Government Member admitted to practice more than 6 years.. .$ 0 Government Member admitted 3 to 6 years,inclusive.. .$ 95.00 Government Member admitted less than 3 years.. $ 65.00 Senior Life Member.. $115.00 Non-Resident Senior Life Member.. 55.00 Members in ACTIVE military service.. 00.00 New Admittee,admitted in Indiana less than six months.. ..$ 00.00 Affiliate member consists of Paralegal, Law,Librarian, Court Administrator or Legal Administrator. Visit www.inbar.org and click on membership information for application. Annual dues are due and payable on the first day of July. Persons applying for membership during the fiscal year(except those newly admitted to practice) shall pay dues pro rated for the balance of the year,computed on a quarterly basis on Oct.1,Jan.1,Apr.1. Visit our website,www.inbar.org, for pro rated figures.(Requirements for membership on opposite side) INDIANA STATE BARASSOCIATION Serving the legal profession and the public c i Name_ � C 1�d'1 ks 114_L' M _ Date J L R (Last) rst) _ (Middle) C Business Address One, i� 1 G :V'u City C as yyie-A State 6 N Zip Code 't U)G> Residence Address �� 1 -i, ��f� 'v I ce- ❑ City CCU TA el State k N Zip Code '1(00'62- (Association communications are mailed to business address unless box after residence address is checked.) Law Firm Name or Company �' -, w NA-rcel Business Telephone � -7) �� I - �`` F � _ E-mail Address 6-f 1(Vka) I ^bate of Birth-7191 r O Place f�r,�� 1 f<� 1 t , `II IrIi124 Area of Practice ,(Al t Q y Race* Wm e_ Sex* College or University S<.:tm Y Aoo ' - t Law School \)f;1eu�7`t.° �eilavN-fir i�5L�1C��'� Lab's Date admitted to practice in Indiana U ( • DO - Other states(and dates)where admitted to prac e aA Spouse name (if married)_ k 0- *Information requested is optional and used only t provide ISBA services.Read the reverse side of this form and submit the dues for which you qualify. Separate at above perforation.Submit top section only. Bylaws of the Indiana State Bar Association provide: 1. SUBMISSION AND APPROVAL. All applications for the membership shall be in writing, upon forms prescribed by the Board of Governors, submitted to the principal office of the Association and shall be accompanied by the tender of such dues as are prescribed for the applicant's category. Proof of eligibility shall be furnished by an applicant upon request by the Board of Governors. Approval of the application shall be by majority vote of the Board of Governors.If rejected for membership by the Board of Governors,the applicant may submit an application to the House of Delegates at its next meeting. 2. RESIDENT MEMBERSHIP. An attorney who is on the roll of attorneys admitted to the practice of law by the Supreme Court of Indiana shall be eligible for Resident Membership. A Resident Member in good standing shall have voting privileges, and shall be eligible to hold any elective or appointive Association office. 3. NON-RESIDENT MEMBERSHIP. An attorney who is duly qualified to practice law in any country,state,territory,district or possession, including the state of Indiana,and who neither resides nor practices law in Indiana,shall be eligible for Non-Resident Membership.A Non-Resident Member shall be ineligible to hold any office in Association. 4. RESIDENT ASSOCIATE MEMBERSHIP.An attorney who is a resident of Indiana and who is duly qualified to practice law in any country, state, territory, district or possession other than the state of Indiana shall be eligible for Resident Associate Membership. A Resident Associate Member shall be ineligible to hold office in the Association but shall be entitled to serve as a full voting member,including service as chair of any committee to which duly appointed and any section duly joined. (Schedule of membership dues on opposite side.Visit the ISBA website at tvww.inbanorg for more information.) Indiana State Bar Association One Indiana Square, Suite 530,Indianapolis, IN 46204 Phone: (317^),639-5465 . (800) 266-2581 e Fax: (317) 266-2588 Name C� l ISBA Membership No. AddressY1 City �_ MmtA State Zip LA(-v o 3 E-Mail Address 0�\))lh("1 CAA f r 'f Nyt k 1`(A , Ca )" Method of Payment: ❑ Check ❑ Visa ❑ MasterCard ❑ Discover Amount due$ /vso Card Number: - Exp Date: - **3-4 Digit Code If paying by credit card,please provide the 3 or 4 digit verification number on the back of your credit card. 'this number is needed to process your credit card. Signature Date Checks payable to:Indiana State Bar Association. Annual dues are recorded for the period of July 1 through June 30. Please check the Section(s) you wish to join and return this form and payment to the ISBA: _Agricultural Law($20) _Elder Law($20) _Land Use&Zoning($15) Alternative Dispute Resolution($20) _Employment& Labor Law($20) _Litigation($15) _Animal Law($15) _Environmental Law($25) _PLEADS ($15) _Appellate Practice($20) _Family&Juvenile Law($15) _Probate,Trust& Real Property($20) _Bankruptcy&Creditors' Rights($30) _General Practice, Solo& Small Firm($15) _Senior Lawyers($10)Age 60+ _Business Law($l0) governmental Practice($10) _Taxation($25) _Construction& Surety($20) Health Law ($15) _Utility Law($20) _Corporate Counsel($10) _Intellectual Property($10) _Young Lawyers($10)* _Criminal Justice($20) _international Law($15) 'Membership in the Young Lawyers Section is complimentary to new admittees and law students. 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 Indiana State Bar Association Purchase Order No. One Indiana Square, Suite 530 Terms Indianapolis, Indiana 46204 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 8-29-12 Membership Dues for Ashley M. Ulbricht Carmel $105.00 Assistant City Attorney, per the attached Membership Application Total $105.00 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 VOUCHER NO. WARRANT NO. ALLOWED 20 ind;ane State Bee s eenatien IN SUM OF $ One Indiana Square, Suite 530 Indianapolis, IN 46204 $ $105.00 ON ACCOUNT OF APPROPRIATION FOR Department of Law #1180 430-55300 Dues Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or 1180 $105.00 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 201,L- Si n re Cost distribution ledger classification if Title claim paid motor vehicle highway fund