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Home My WebLink About216742 01/29/2013 CITY OF CARMEL, INDIANA VENDOR: 00351693 Page 1 of 1 ONE CIVIC SQUARE HYATT REGENCY DENVER CHECK AMOUNT: $671.28 CARMEL, INDIANA 46032 AT COLORADO CONVENTION CENTER o� 65015TH STREET CHECK NUMBER: 216742 DENVER CO 80202 CHECK DATE: 1/29/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 210 4357000 671 . 28 TRAINING SEMINARS INVOICE Date: January 24, 2013 Sold to: City of Carmel Police Department 3 Civic Square Carmel, IN 46032 Payment for lodging for Ann Gallagher on April 13 - 16, 2013 in Denver, CO Confirmation #326LHS22 Room Rate Tax Total $195.00 $28.76 $223.76 x 3 = $671.28 TOTAL DUE: $671.28 Please make check payable to: Hyatt Regency Denver at Colorado Convention Center 650 15`h Street Denver, CO 80202 fir Y NATIONAL CONFERENCE ON HIGHWAY SAFETY PRIORITIES CONFERENCE REGISTRATION FORM j_IFESAVERS 2013 APRIL 14-16, 2013 - COLORADO CONVENTION CENTER - DENVER PAGE 1 ATTENDEE INFORMATION First name: f� `�' Last name: Preferred first name for badge:-4m Yv Privacy Disclaimer. C•�r s� ��// ( you registering for this conference Organization: c you acknowledge that your contact Address: C ' `�` S /f �CA/ information will be included on the � —a ) attendee list made available to City: �� State-T Zip: `(4,U3 L all meeting registrants,including _ exhibitors. Only exhibitors have Telephone: ( 31 1 �7� -�S UU Cell: 1 I the opportunity to purchase G�/ Foru elesonl�—raillnotbeprutled// P�r�ooramnmlori�ls the attendee list. Attendee Email: / / (r C:III C�'t`f �.e�FY ✓1 f'/ �+`� (IZ� �/ %� S G -e ` �_� r _v Initial here if you on not Email a copy of registration info to: � �t3r►� / (T(/ want your contact information Enter allerrrafe Cmar1 nnlp included in conference materials. Special Requests: Emergency Contact Name(required): Day Phone:( ) L 13 31 Evening Phone: D-1-5-av—e read and accepted the Liability and Photography Waiver on page 2 of this registration form. ?''Please check food functions you will be attending: `J�p�Gr a �- wewl �U��e`�O�Lf%Slzl Coy Sunday Box Lunch IAonday Continental Breakfast (&Tuesday Closing Breakfast Plenary Sunday Opening Reception %PIWonday NHTSA Awards Luncheon Will you be staying at the one of the Conference hotels? Ca'1*es ❑No If not,where will you be staying? Is this your first Lifesavers Conference? ❑ Yes ;"o What field do you work in? ❑Consultant/Researcher ❑Community Programs ❑Local Government ❑Advocacy/Consumer Group ❑Insurance Industry ❑EMS/Fire ❑State/Federal Govt. ❑Judge/Prosecutor ❑Child Passenger Safety ❑Public Health/Medical ❑Auto Industry ❑Law Enforcement ❑Child Restraint Manufacturer ❑Student *Which workshop track(s)will you most likely be attending? /I ❑Adult Occupant Protection ❑Distracted Driving ❑Teen Traffic Safety ❑Impaired Driving ❑Roadway Safety 90ccupant Protection for Children ❑Other Highway Safety Priorities ❑Criminal Justice/Law Enforcement ❑Communications ❑Vulnerable Populations(Bicyclists/Motorcyclists/Pedestrians/Older Drivers) PRE-CONFERENCE WORKSHOPS I am registering for: Y5 CPS Latest Technology Workshop Details on Pre/Post activities page of our website. "t REGISTRATION FEES (Checkone) Your registration fee includes an opening reception,two breakfasts,two lunches,refreshment breaks,exhibits,workshops,and program materials. 4—Early-Bird Special-Until January 11,2013 $350 ❑ Regular Registration-After January 11,2013 until March 1,2013 $400 ❑ Late/On-Site Registration-After March 1,2013 $500 ❑ Moderator/Speaker $350 paying by credit card or ❑ Moderator/Speaker(attending day of presentation only) Indicate day: $0 purchase order? ❑ Poster Presenter $350 You can also securely ❑ Approved Undergraduate/Graduate Student-Registration Code: $50 register online at Note:Additional exhibit personnel-please use the exhibit registration form. Total Amount Due $ www.lifesaversconference.org WWW.LIFESAVERSC0NFERENCE.0RG REGISTRATION FORM PAGE 2 PAYMENT METHOD I Check one ❑Visa ❑MasterCard ❑Check ase Order(see below) Total Amount$ �2-5 0 'ob ❑1 agree to pay the above total amount according to card issuer agreement. Card Number: Expires: / CW2 Code: In 1, 3�, m_o:i,,,, 11,.ac:o-V'•.i ::, iil„h ,.rpdi(a1- ,c Signature: Print name as it appears on card: Billing Address: City/State/Zip: Purchase order must be attached.Indicate bill-to address below if different from registration address. Attention%E��l-� /�`� be 5,ol— Organization: --/'/!,-' Address:�Ciy� r: S �(r/� City/State/Zip: (?,4rr2.e i V(n03 Z PAYMENT TERMS 11! Registration fees must be paid by check in U.S.dollars payable to Lifesavers Conference,Inc.,credit card(Visa or MasterCard—we do not accept American Express)or attached purchase order. 0 Registrations received without payment or purchase order number will not be processed. E3 Registration must be mailed by April 4,2013.After that date wait and register on-site. Lifesavers Fed.ID H:52-1648356 Mail form with payment or purchase order to: Or Fax: Lifesavers Conference,Inc. (703)922-7780 Do not mail form after faxing. Conference Registration PO.Box 30045 Alexandria,VA 22310 NOTE:If you do not receive a confirmation via email or U.S.mail within 14 days,please contact us at(703)922-7944 or email us at lofgren @meetingsmgmt.com CONFERENCE LODGING Of Headquarters:Hyatt Regency Denver at the Colorado Convention Center 13 Sheraton Denver Downtown Reserve your room online via a link on the Travel/Hotel page of our website. CANCELLATION POLICY Lifesavers does not accept cancellations by phone. Cancellations must be mailed to Lifesavers Conference,or emailed to Lofgren @meetingsmgmt.com. You will receive a confirmation of your cancellation.Requests received by March 29,2013 will be refunded less a$25 administration fee.Refunds will be issued after the conference.Requests made after March 29,2013 or"no-shows"are not eligible for a refund. LIABILITY/PHOTOGRAPHY WAIVER By registering for the Lifesavers 2013 Conference,you agree and acknowledge that you are participating in Lifesavers Conference events and activities on your own free and intentional will.You acknowledge this freely and knowingly and that you are,as a result,able to participate in Lifesavers Conference events and hereby assume responsibility for your own well-being.This acknowledgement includes your guest(s)participation in any tours and evening events. The Lifesavers Conference plans to take photographs during the 2013 conference and reproduce them in Lifesavers educational,news,or promotional mate- rial,whether in print,electronic or other media,including the Lifesavers website.By participating in the Lifesavers 2013 Conference,you grant Lifesavers to reserve the right to use your name and photograph for such purposes.All postings are property of Lifesavers,and may be displayed or used by Lifesavers for any purpose. WWW.LIFESAVERSCONFERENCE.0RG 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)) 01/24/13 lodging $671.28 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 Hyatt Regency Denver at Colorado Convention Center IN SUM OF $ 650 15th Street Denver, CO 80202 $671.28 ON ACCOUNT OF APPROPRIATION FOR CPD Continuing Ed Fund PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 210 -570.00 $671.28 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 Thursd y, January 24, 2013 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund