217198 02/13/2013 - Page 1 of 1
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- - - -- $79.00
VENDOR. 143001 CITIES&TOWNS CHECK AMOUNT:
OF CARMEL,INDIANA INDIANA
ASSOC OF CHECK NUMBER: 217198
C'•� CONFERENCE REGISTRATION CHECK DATE: 211312013
200 S MERIDIAN ST,SUITE 340
ONE CIVIC ANA 46032 INDIANAPOLIS IN 46225
J CARMEL, DESCRIPTION
A MOUNT
AL INSTRUCT FEE
po NUMBER INVOICE NUMBER g . 00 EXTERN
ACCOUNT Col."j) �
DEPARTMENT 4357004
1'701
2013 TACT LEGISLATIVE DAY REGISTRATION
® PRE-REGISTRATION DEADLINE, �AARCH 12
YOUR INFORMATION R GISTRATION FEES
Name I1/i, r $79IACT member/Associate
K� Member
Preferred Name for Badge 1.t
❑$99 TACT Member/Associate
P City/Company Member(late or onsite)
Title &Ift
n���p� �� 0 ❑$130 Non-member
� j/( --a C.) I��,/ ❑$150 Non-member(late or
Address G G'j L j�' onsite)
i l
City/Town ❑$40 Spouse/Guest'
State Zip Y D !1 ❑$60 Spouse/Guest*(late or
oC onsite)
• • Phone z,
• ,I _ Email 4( Total$
Name of Spouse/Guest(if attending) Please check the events you plan
to attend.This is for planning pur-
' Special Needs and Dietary Restrictions poses only.No extra fees apply.
• •• ❑Legislative Briefing
• • • e e • ❑Legislative Luncheon
• • 'The guest registration fee is
-e •
METHOD OF PAYMENT restricted to those accompanying
a registered attendee and who
have no professional interest in the
•; • . • • (Circle One) Check MasterCard Visa Discover conference.The fee includes ad-
Check Number mission to all conference sessions
e • and meals.
•e • • • • Card Number
CANCELLATION POLICY
• •• •• Expiration Date 3-digit Security Code Only written conference cancella-
' • • tions received on or before March
• s o Name of Cardholder 12 will be refunded,minus a$40
. Authorized Signature processing fee.Fax your cancella-
tion to(317)237-6206 or email to
kstorms@citiesandtowns.org.
• • • • Billing Address(if different from information section)
HOW TO REGISTER
MAIL form to:
City TACT,200 S.Meridian,Suite 340
• • • • Indianapolis,IN 46225
e •e ° - State Zip FAX form with credit card info to:
(317)237-6206
Prsrt Std
US Postage
'M". PAID
Indp1s, IN
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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
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.
ALLOWED 20
���T ��" � e2�`� u IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#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