223010 08/13/2013 CITY OF CARMEL, INDIANA VENDOR: 143001 Page 1 of 1
ONE CIVIC SQUARE INDIANA ASSOC OF CITIES&TOWNS
TI� CARMEL, INDIANA 46032 CONFERENCE REGISTRATION CHECK AMOUNT: $295.00
200 S MERIDIAN ST,SUITE 340 CHECK NUMBER: 223010
"0N` INDIANAPOLIS IN 46225
CHECK DATE: 8/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4357004 295 . 00 EXTERNAL INSTRUCT FEE
2013 IACT ANNUAL CONFERENCE & EXHIBITION REGISTRATION FORM
Pre-Registration Deadline: September 20
Full Name Di a-in� �;. at-dr i City/State/Zip ��—{yt U ��
Preferred Name for Badge Phone
Title �r t' � j, - f r Email CC U /it, e
First Time Attendee? ❑ Yes ❑ No Spouse/Guest Name
Municipality/Company ( f. __ rn Special Needs and Dietary Restrictions
Council President's Name�� i �' C l �L,
2
Address CC68 11A6 c�c_rt
REGISTRATION FEES METHO �OF PAYMENT
r ,C�
r i L Check 0 Visa ❑ MasterCard ❑ Discover
Member Municipal Official(Population $295 $350 /�S Check#(Payable to TACT)
greater than or equal to 1,000) ��f(
Cardholder Name
Member Municipal Official(Population $175 $225
less than 1,000)
Credit Card Number
Associate Member $295 $350 Expiration Date
Spouse/Guest* $175 $225
3-digit Verification Code
Non-Member $425 $475 Billing Address
Municipal Day(Monday Only) $225 $275 City/State/Zip
Total Amount: $ Signature of Cardholder
*The spouse/guest registration fee is restricted to those who are not municipal officials and who have no professional interest in the conference. The tee includes admission
to all conference events,the exhibit hall,meals and participation in the spouse/guest program.
Plea a Check the Conference Events You Plan to Attend (For planning purpose only)
SUNDAY, ❑SUNDAY, Cl SUNDAY, • SUNDAY, ❑ MONDAY, -MONDAY, MONDAY, TUESDAY,
Opening Business Workshop#1: Workshop#2: Welcome Continental Annual Awards Presidents' Closing Brunch&
Session Maximize Trans- Review of Public Reception Breakfast Luncheon Reception Business Session
portation Dollars Meetings
-The TACT Annual Awards Luncheon has assigned seating.Only registrants who check the Annual Awards Luncheon above will be assigned a seat.We will do our best to
accommodate seating requests. Requests are not guaranteed. Please note if you would like to network with other communities and prefer to not be seated with other
attendees from your community.
Seating Requests:
Cancellation Policy Special Needs and Dietary Restrictions Additional information for affiliate group members may be
Only written cancellations will be accepted. Please mail your If you require special arrangements or a special diet,please mailed out separately.
written cancellation to 200 South Meridian Street,Suite 340, notify IACT on your registration form.
Indianapolis,IN 46225;fax to(317)237-6206 or send to Questions?
kstorms @citiesandtowns.org. Written cancellations received Affiliate Group Events Contact Natalie Hurt at 317-237-6200 ext.233 or
on or before September 25,will be refunded less a$40 IACT affiliate groups may hold individual meetings and nhurt®citiesandtowns.org
processing fee. (ACT is not responsible for hotel reservations events at the conference.Attendees must be registered
or cancellations. for the conference in order to attend affiliate events. E-Verify Compliance
TACT is an enrolled employer in the E-Verify Program verify-
ing the work eligibility status of its new employees and will
1 I' li remain so until that program no longer exists.
INDIANA ASSOCIATION OF CITIES AND TOWNS
7
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
I � Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
/ ll o
! 1 i
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
I�IC� - � 6. Ai' '�s7771---2,aS
IN SUM OF $
U
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
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund