Loading...
HomeMy WebLinkAbout216790 01/29/2013 a M CITY OF CARMEL, INDIANA VENDOR: 360710 Page 1 of 1 ONE CIVIC SQUARE LIFESAVERS CONFERENCE INC CHECK AMOUNT: $350.00 CARMEL, INDIANA 46032 Po Box 30045 ALEXANDRIAVA 22310 CHECK NUMBER: 216790 CHECK DATE: 1/29/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 210 4357000 21230 350 . 00 TRAINING SEMINARS Anderson, Teresa K From: Gallagher, Ann Sent: Tuesday, January 15, 2013 7:26 AM To: Anderson, Teresa K Subject: FW: 2013 Lifesavers Conference Registration INVOICE From: Lifesavers Conference Registration Staff [mailto:csl@blueskyz.com] Sent: Monday, January 14, 2013 10:45 PM To: Gallagher, Ann Subject: 2013 Lifesavers Conference Registration INVOICE rn IN llskl .;.gip. µp a^. to. "�k r,• a•. ,:«r, µ�?�,ry,�, .a• s� ,..a a«' h;«T'\<.. INVOICE Dear Ann Gallagher, Thank you for submitting your registration for the Lifesavers National Conference,April 14-16,2013,at the Colorado Convention Center in Denver. Please send a copy of your purchase order one of the following ways:email us at Lofgren(d)meetingsmgmt com:fax to 703-922-7780,or mail to.Lifesavers Conference,Inc.,PO Box 30045,Alexandria,VA The details of your registration via check payment appear below: Name of Attendee:Ann Gallagher Payment authorization by:Pay by Check-Mail Check Amount:$350.00 Total Event Fees Due:$350.00 Registration Confirmation#:21230 ITEM(S)ON INVOICE#21230 QTY DESCRIPTION PRICE TOTAL 1 Early-Bird Special $350.00 $350.00 Checks are made payable and sent to: Lifesavers Conference,Inc. PO Box 30045 Alexandria,VA 22310 Federal Tax ID is 52-1648356 This email serves as your invoice and commitment for check payment for the total registration amount listed above.Please retain this email for future reference If you have any questions regarding your registration,please contact Customer Service at cs1(djblueskyz.com.If you have specific questions regarding the Lifesavers Conference,email lofgren(rilmeetingsr 922-7944. Check www.lifesaversconference.org for updates. Looking forward to seeing you in Denver! NATIONAL CONFERENCE ON HIGHWAY SAFETY PRIORITIES CONFEREN RE C GISTRATION FORM L11F'ESAVERS 2013 APRIL 14-16, 2013 • COLORADO CONVENTION CENTER • DENVER PAGE 1 ATTENDEE INFORMATION First name: / Last name: Preferred first name for badge: Alm I'v Privacy Disclaimer. /1� f / By registering for this conference C Organization: e-f e �/ //u 1 f you acknowledge that your contact Address: C ' `�` (_ S /Cf Lcth�� information will be included on the attendee list made available to City: ��%' /7,1-e f State Zip: Y�U3 z all meeting registrants,including _ exhibitors. Only exhibitors have Telephone: ( 3 i ) E-7/ —aS Uy Cell: ( I the opportunity to purchase For updates nN7-mill riot he printedd n propmrn matcrials the attendee list. Attendee Email: ��rC��Lt C he e c�rti-i / -��• G L� " / �- / _ Initial here if you do not Email a copy of registration info to: 1.f'n/�> T- S �J t��r" �� ' �/✓ want your contact information Enter dltemare email only included in conference materials. Special Requests: Emergency Contact Name(required): Day Phone.( r✓ — Evening Phone D-1 ave read and accepted the Liability and Photography Waiver on page 2 of this registration form. 'Please check food functions you will be attending: eGr 4 Sunday Box Lunch Monday Continental Breakfast Tuesday Closing Breakfast Plenary I Sunday Opening Reception I%%`�plonday NHTSA Awards Luncheon Will you be staying at the one of the Conference hotels? 21f'e5s ❑No If not,where will you be staying? Is this your first Lifesavers Conference? ❑ Yes 7-No 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? ❑Adult Occupant Protection ❑Distracted Driving ❑Teen Traffic Safety ❑Impaired Driving ❑Roadway Safety Occupant 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: V�CPS Latest Technology Workshop Details on Pre/Post activities page of our website. REGISTRATION FEES (Checkone) Your registration fee includes an opening reception,two breakfasts,two lunches,refreshment breaks,exhibits,workshops,and program materials. ' —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 Checkone ❑Visa ❑MasterCard ❑Check Lrefiase Order(see below) Total Amount$ 711 agree to pay the above total amount according to card issuer agreement. Card Number: Expires: / CW2 Code: Toe CW?wde is 3 dp!rode iounn ct the Carl of you.n dtt r,;sf I-ing he rredn raid n,,i 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. AttentionE> :�f� � �P:�0/`� Organization: �C A-o e/���(e Address: (1, zar C S�te W� r City/State/Zip. Carry�2 i `' ��003 Z PAYMENT TERMS 0 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. El Registrations received without payment or purchase order number will not be processed. © Registration must be mailed by April 4,2013.After that date wait and register on-site. Lifesavers Fed.ID# 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 P.O.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 • Headquarters:Hyatt Regency Denver at the Colorado Convention Center • 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 INDIANA RETAIL TAX EXEMPT PAGE City o � CERTIFICATE NO.003120155 002 0 1i PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 35-60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, SHIPPING LABELS AND ANY CORRESPONDENCE. FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 119 Lifesayeis Conference, Inc. Camel Police Depaoment VENDOR TOIP 3 CIVIC squait P.O. Box 30045 Camel, Its 46M Alexandria. VA 22310 (3j7)67j-2&% CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 00.670.00 1 Each draining $350.00 $350,00 r Sub TOtW. $350.00 l dE °. a Send Invoice To: I.Ifesavers 2013 conference ( M Wor o y;'A 3 "16, 2013 In Donver,CO fJ ties Carmel Police Department Attn: Teresa Anderson 3 Civic Squam Carmel, IN 4I== PLEASE INVOICE IN DUPLICATE DEPARTMENT \ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT Carmel Police Dept. PAYMENT M0.00 • A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. • •C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY •PURCHASE ORDER NUMBER MUST APPEAR ON ALL J,•�J- SHIPPING LABELS. !V/ •THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE Ifthilsf at Mien AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK TREASURER DOCUMENT CONTROL NO. A.P. COPY-SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO.__._—_-___.WARRANT NO,,_.,_....._------ _ ALLOWED 20 IN THE SUM OF$ ON ACCOUNT OF APPROPRIATION FOR Board Members - or INVOICE NO. ACCT#[TITLE AMOUNT DEPT.# I 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. 20 _........................... ......................._..._ - --.......__.........__._..-..---.._..__._......-----.....-.--..-. - ._..... Signature ..........................................................................._...__....._..._........................-. Title Cost distribution ledger classification if claim,paid motor vehicle highway fund VOUCHER NO. WARRANT NO. ALLOWED 20 Lifesavers Conference, Inc. IN SUM OF $ P.O. Box 30045 Alexandria, VA 22310 $350.00 ON ACCOUNT OF APPROPRIATION FOR CPD Continuing Ed Fund PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 25605 I 21230 I -570.00 I $350.00 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 Thursday, January 24, 2013 Zchief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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)) 01/14/13 21230 training $350.00 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