219737 05/07/2013 CITY OF CARMEL, INDIANA VENDOR: 359978 Page 1 of 1
ONE CIVIC SQUARE GOLF COURSE SUPER.ASSOC OF AME�RRI
CARMEL, INDIANA 46032 1421 RESEARCH PARK DR CCK AMOUNT: $415.00
LAWRENCE KS 66049-3859 CHECK NUMBER: 219737
CHECK DATE: 5/7/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4355300 315520 415 . 00 ORGANIZATION & MEMBER
GCSA A
REMIT TO: 164825
1421 Research Park Dr, Lawrence, KS 66049-3859
Call: (800)472-7878 Fax: (785)832-3643
DUES INVOICE
Renew OnLine Today @ www.gcsaa.org OR PLEASE SIGN&Return with pmt.
315520
Your preferred mailing address: 7/1/2013-6/30/2014
164825 A
Robert D. Higgins Other Address: 024887
PO BOX 960
Westfield,IN 46074-0960 Brookshire Golf Course
UNITED STATES 12120 Brookshire Pkwy
Carmel,IN 46033-3314
UNITED STATES
Your Class A Renewal Cycle is: 04/06/2011-04/05/2016 Would you like to continue to receive ❑YES❑NO
Golf Course Management magazine.
CHAPTER MEMBERSHIP Use the spaces below to update your home and/or golf course information.
NEW Home Mailing Address: (Provide ONLY if changed address.)
Indiana GC5A,Michiana GCSA no bo'e q(-0
Street or P.O. Box(1)
Vote is with: None Street or P.O. Box(2)
City,State,Zip Trk , L(o C.? J �
IF YOU WOULD LIKE TO CHANGE YOUR VOTE, "[ �-('
PLEASE CONTACT MEMBER SOLUTIONS @ 1-800- Country
472-7878 FOR AN AFFIDAVIT. Phone �� � ��� (� Fax
Current E-mail Information: If possible,please provide a mailing address that includes a street address. Fed Ex will
not deliver to a PO Box.
NEW Golf Course Information:
(Provide ONLY if you have changed positions.) Date started
bhiggins @carmel.in.gov
Golf Course Name
Street or P.O. Box(1)
Please update below,if needed: Street or P.O. Box(2)
City,State,Zip
Preferred E-mail(To be used for all GCSAA Country
correspondence) IIi,
PUBLISH E-mail address in the [ ES❑NO Fax
Membership Directory? / Phone
GOLF COURSE MANAGEMENT GIFT SUBSCRIPTIONS)
You may,as a professional courtesy,send a maximum of two Goff Course Management(GCM) subscriptions to your club president,green chairman,
employer or other appropriate party.
To send complimentary subscriptions to a new/or different person,go to http://www.gcsaa.org/profile/giftsub.asox
REN
164825 A Robert D. Higgins 315520 7/1/2013-6/30/2014 $365.00
i
�o
To continually improve membership programs and resources,please provide the following information. Your participation will enable your association to build
the most comprehensive database in the golf course management industry.
1.What is your annual maintenance budget?(circle one)
a.Les han$250,000 d. $750,000-$999,999 g. $1,500,000 and over
b.$250 000-$499,999 e. $1,000,000-$1,249,999
c.$500,000-$749,999 f. $1,250,000-$1,499,999
2.What percentage of your annual maintenance budget is spent on the following categories?If necessary,provide an estimate.
(Total must add up to 100%)
a. �C %Labor(include all payroll expenses: salaries,hourly wages and labor contracts)
b. %Water(include all water costs)
C. S %Other(include all remaining items in your maintenance budget)
3. How many golf holes are maintained through your annual maintenance budget? Enter number of holes
4.How much do you spend annually on maintenance equipment purchases and leases?$ /A) 0o6-i
5.What is your predominant turf-type on:tees PO IN- fairways JZ" greens POA
6.What percentage of your maintenance fleet is owned vs.leased?Own_S_%Lease_%(Total must add up to 100%)
]In order to report.on diversity elfforts withinthe association.Please answer the,,follllowiin�
What is your gender?_Male—Female
Which of the following best describes your ethnicity? ����
White Black/African American The EIFG fosters sustainability through
Hispanic/Latino Asian research,awareness,education,programs
Multiracial American Indian/Native American/Alaskan Native and scholarships for the benefit of golf
course management professionals,golf
facilities and the game.
Birthdate d7 j L w((mm/dd/yyyy) Are you a citizen of the United States? PY ❑N
For more information regarding the life insurance benefit,go to www.gcsaa.org and search for Affinity
Programs.
GCSAA Bylaws require that the following information be confirmed and returned with your annual dues remittance.
Your current job title or position is: If your position/responsibilities have changed and you have not contacted us,please
visit www.gcsaa.org/membership and complete a reclassification form.
Golf Course Superintendent
Title I hereby certify that my information is correct.
Semi-private 18 X Member's Signature Date 3
Facility Type #Holes
Renewal form will,be' returned to member ifmot
Please Make A Copy For Tax Purposes: GCSAA dues are not deductible as a charitable contribution for federal income tax purposes,but may be deductible as
an ordinary and necessary business expense. GCSAA estimates that 6%of your membership dues are not deductible as this portion will be used for advocating positions on
government issues,as well as for the payment of dues term Life insurance for all members excluding students,affiliate companies,technical assistance network,International
Superintendent Member(ISM)and non-U.S.citizens.
The Environmental Institute for Golf is exempt from taxation under Code Section 501(c)(3)of the Internal Revenue Service. Your voluntary gift is deductible as a charitable
contribution for federal tax purposes to the extent provided by law.
METHOD OF PAYMENT
:: ;• _:. ;<: Y < :..wM,rMembership Dues $365.00
❑Check Enclosed ❑American Express p 7
❑MasterCard ❑ Asa -R
US.Funds Only(U.S dollars drawn on U.S. bank) �L- " epad Amognt $0.00
.g --? ::: .a..:.:.,ac•_ J L"' "
OTA DUES OWED $365.00
CreditCar_J_# - Uol uritary:Coritril iutionto The EnviitinineritalInstitutef6r,fiolf $50.00
..�:<.,,r,s _t'ibu.;.av:.�_:::ts.:..._.rtc:..
x �°`z�:TOTAL'.DUES'an C NT IB T N $415.00
Expiration Date Card Holder Name(please print) ;
yy ;Join or�renew the Golden Tee Club by contnbuhng an addrtronal,
XSignature
xr xe r z V, ✓
Make checks payable to: GCSAA :d r ` ,4 TOTAL AMOUNTINCLOSEDI
REMIT TO: 1421 Research Park Dr,Lawrence,KS 66049-3859 - Call:(800)472-7878 Fax:(785)832-3643
REN
164825 A Robert D. Higgins 315520 7/1/2013-6/30/2014 $365.00
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))
07/01/13 315520 Dues $415.00
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
GCSAA 00 T ,/
" IN SUM OF $
�i4t21L �2 i J�
Ks
$415.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1207 I 315520 I 43-553.00 I $415.00 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
Friday, May 03, 2013
J"/
Director, Brookshlr Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund