215434 12/11/2012 f CITY OF CARMEL, INDIANA VENDOR: 363439 Page 1 of 1
,( ONE CIVIC SQUARE U S A TABLE TENNIS CHECK AMOUNT: $75.00
a 1 OLYMPIC PLAZA CARMEL, INDIANA 46032
+M rON`a COLORADO SPRINGS CO 80909 CHECK NUMBER: 215434
CHECK DATE: 12/11/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4239039 1 75 . 00 GENERAL PROGRAM SUPPL
llS
TABLE TENNIS
it
Club Affiliation Form DEC 42012 ,
BY:
Annualfee ..................................................... $75.00
CLUB NAME: Monon Community Center Table Tennis Club
Please answer all of the questions completely:
PLAYING SITE ADDRESS (be complete):*
(Any additional playing sites may be listed on page 2)
Name of Building: Monon Community Center
Address: 1195 Central Park Drive West
City/State/Zip Code Carmel IN 46032
What are the Club hours of operation: * Tuesdays: 7:00pm-9:30pm and Saturday
l 0:00am-1:OOpm
CLUB MAILING ADDRESS (if different from playing site):
Correspondent's Name: Matt Leber
Address: 1235 Central Park Drive East
City/State/Zip Code: Carmel, IN 46032
Telephone No: (Home) _317-573-5248 (Work) _317-573-5248
Email Address: mleber2cannelclayparks.com
CLUB CONTACT:*
Name: Matt Leber
Telephone No: (Home) 317-573-5248 (Work) _317-573-5248
Email Address: mleber�carmelclayparks.com
Club Website: http://www.carmelclayparks.com/programs/adults/table-tennis
CLUB OFFICERS:
President: Matt Leber
Telephone No. _317-573-5248
Email Address: mleberncarmelclayp arks.com
Vice President:
Telephone No.
Email Address:
Secretary:
Telephone No.
Email Address:
Treasurer:
Telephone No.
Email Address:
1
At"' USA
TABLE TENNIS
Does the club have a membership structure? Yes No X
If yes, please describe (For example, does the club maintain a membership list? Are membership
fees monthly, annual? What are the membership fees?):
If yes, how many members does the club currently have?
How many tables does your club use when open for play?_Twelve
What programs does your club offer/provid'e? (For example: Leagues, Coaching, Tournaments,
Open Play, Junior Program) Open Plan, Tournaments, Leagues
Does the club have a bank account? Yes No x the department does, but not
specific to the club
Additional Multiple Location Information
PLAYING SITE ADDRESS (be complete):*
Name of Building:
Address:
City/State/Zip Code
What are the Club hours of operation:
*Unless otherwise requested, this information will appear in USATT publications.
Please return completed form to the following address:
USA Table Tennis
Attn: Membership Director
4065 Sinton Rd. Ste. 120
Colorado Springs, CO 80907
Telephone#: 719-866-4583 X5
Fax #: 719-632-6071
2
Carmel • Clay
Parks&Recreation CHECK REQUEST
Date: 11/30/12 LUC 4 2 012
I
Check payable to:
Name: USA Table Tennis
Address: 4065 Sinton Road, Suite 120
City, State, Zip Colorado Springs, CO 80907
Mail check to payee x Return check to requestor
Check Amount: $ 75.00 Date Required: 12/14/12
Check needed for: USA Table Tennis Club Affiliation Fee
To be paid from:
PO#(if applicable)
Budget account-GL# 1096.50.4239039
Budget Line Description General Program Supplies
Invoice(s) and Purchase Order(if required)MUST be attached.
Requested by(print): L
Requested by(signature):
Approved by(signature of Division Manager)
V
on this date 12I SI 12_
Form revised 7-7-08 Shared/Forms/Business Services/Check Request Form/Check Request(rev 7-7-08)
•j „��
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
USA Table Tennis Terms
4065 Sinton Rd., Ste 120
Colorado Springs, CO 80907
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
12/4/12 Ck request Club affiliation fee $ 75.00
Total $ 75.00
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.
USA Table Tennis Allowed 20
4065 Sinton Rd., Ste 120
Colorado Springs, CO 80907
In Sum of$
$ 75.00
ON ACCOUNT OF APPROPRIATION FOR
109 -Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1096-50 Ck request 4239039 $ 75.00 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
6-Dec 2012
Signature
$ 75.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund