227443 12/17/2013 CITY OF CARMEL, INDIANA VENDOR: 00351245 Page 1 of 1
ONE CIVIC SQUARE NATIONAL LEAGUE OF CITIES CHECK AMOUNT: $450.00
CARMEL, INDIANA 46032 PO BOX 17425
BALTIMORE MD 21298-8220 CHECK NUMBER: 227443
CHECK DATE: 12/17/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4357004 CORDRAY 450 . 00 EXTERNAL INSTRUCT FEE
NLC Congressional Cities Conference Registration and Housing Form
March 8th—12th,2014
The Marriott Wardman Park Hotel,Washington,D.C.
For Faster Registration and Housing Reservations,Register Online at htta:flviww.nic.org
Hotel Reservations: You must be registered for the Conference to reserve a hotel room. To guarantee
No housing orregistration will be processed without accompanying paymentin full. your room,all hotels require one night's depositplus 14.5%tax(subject to change),30 days prior to
— your arrival.This is required even if you plan to arrive before 6:00 p.m. If accommodations are not
Are you a n I elected Official? M--\i _ Size of city? h 3 (' guaranteed 30 days in advance,the reservation will be cancelled.
Name � 11 7/1 lea\ PC, ,4 yr" Gender � U Please make my hotel reservation as indicated below.
Title t{Z r U'r�.ir(� oL !� F i i°I( U I do not require hotel accommodations at any of the hotels listed below.
*t /� v (_] Although 1 am providing information for a standard room for now—please contact me
City/Organization �_-iv ;n�4 regarding suite information. J
Mailing Address (l—fix �i e @ Room Dates: Arrival Date: All/.(3 Departure Date: !'
City iN 10 State Zip I
Phone 4 / ��L (� Fax s'/ L.-Q9 U Room Type: Single,1 person/1 bed L] Quad,4 people/2 beds
r L Double,2 people/l bed �]
Email 4,� f c� r�, I�� r j,IA� L] Double/Double,2 people/2 beds L]Registrant's Email �-GV 'D I� L] Triple,3 people12 beds
� .7 A Room types cannot be guaranteed but Hotels will allempt to accommodate all requests.
Youth Delegate* (Name) ge
Special Conference Rates ----
Sharing My Room With(for Hotel Check In Purposes):
Spouse/Guest(non-refundable)$70 $
First-Time Attendee$425 $ Special Housing Request(e.g.,wheelchair accessible rooms,etc.):
Youth Delegate (15-18)$120 $ If you have special housing or transportation needs,please contact NLC Meeting Services at 866.229-
Youth Chaperone(not applicable to elected officials) $120 $ 2386 or 301.694.5243
Students $125 $ Hotel Choices: Indicate your first-choice hotel with the number°1'. Number the other hotels in order of
Registration Fees: Advance On-Site @COC'
preference.The Marriott Wardman Park Hotel is the headquarters hotel.
Valid Until 317114 Starting Y12114 Valid until 112114 NLC Rate
NLC Member City $545 $645 $450 $ �d Orde Hotel Single/Doublefrdp/Quad
SML Member City $670 $770 $525 $ Mariott Wardman Park $262/$2621$1282/$302
Non-Member/Other $775 $875 $575 $ Omni Shoreham $2481$248/$268/$288
On-site rate includes 100.00 processing fee.To receive advance rate,mailed or faxed registrations Registration Fee Payment Information
must be postmarked by March 1't 2014. Visit www.nlc.orn and register online to ensure you meet (� Charge my REGISTRATION FEES to VISA,MasterCard or AmEx listed below
the March deadline. [5]/Check for REGISTRATION FEES made payable to National League of Cities
(] Purchase Order for REGISTRATION FEES-copy must be enclosed&payment must be received
*Must include Congress of Cities registration ID number to qualify. by February 14,2014.
Hotel Deposit Payment Information(you must check one):
2014 Constituency Group Special Event Fees [] Charge my HOTEL DEPOSIT to the credit card listed below.All major credit cards with expiration
Any NLC registered delegate may attend by paying the fees below,Visit the website formore information � J date of 03/14 or later are accepted by the NLC official hotels.
`
on constituency groups. M Check for HOTEL DEPOSIT.I understand check deposits for hotel room guarantee is payable to the
Asian Pacific American Municipal Officials hotel stated on the NLC confirmation and must be mailed after January 24,2014 but before
APAMO Reception $40 February 20,2014 and are subjectto approval.Please include your 6-digit REG ID#indicated on
Gay,Lesbian,Bisexual and Transgender Local Officials the NLC Meeting services confirmation.
GLBTLO Reception $40
Hispanic Elected Local Officials Credit Card Authorization: NLC Registration and Housing Services is authorized to use the card below
HELD Reception $40 to pay all applicable registration fees and guarantee my hotel reservation.I understand that one night's
National Black Caucus of Local Elected Officials room charge will be forfeited if I fail to show up for my assigned housing on the confirmed arrival date
NBC-LEO Reception and Hospitality $99 unless I have canceled my reservation with the hotel at least 72 hours in advance.I understand that if I do
Women in Municipal Government not show at the hotel on my confirmed arrival date,my reservation will not be reinstated for the
WIMG'A Capital Feast'Luncheon $40 remainder of the stay unless I instruct the hotel to reinstate my reservation. Reinstated reservations are
subject to hotel's availability.Further,I agree to the stated Registration Cancellation policy and I
understand upon cancelling my registration I will accrue a$100.00 non-refundable processing fee.
Celebrate Diversity Breakfast $ $35 Visa/MasterCard/AmEx Number Exp.Date_
TOTAL REGISTRATION FEE: $ Card Holder Name
Card Holder Signature
Registration Cancellation Policy:
All cancellation requests must be received in writing,postmarked by February 14,2014 and are subject Additional Credit Card Authorization: For hotel deposit only if different than the credit card number
to a$100 cancellation fee.No partial refunds will be made if you decide not to attend particular functions. listed above. (Expiration date must be 3114 or later,per hotel requirement.)
No registrations or cancellations will be accepted by telephone.No cancellations will be accepted Credit Card Number Exp.Date_
after February 14,2014 Card Holder Name
Card Holder Signature
***Make a copy of this form for your records
Return Conference Registration and Housing Form to:
Fax: 301-694-5124(Credit Card and Purchase Orders Only—No Checks)
Mail: NLC Registration&Housing Services,clo Experient
PO Box 4088 Frederick,MD 21703
For More Information:
Telephone: 866-229-2386 or 301-694-5243
E-mail: nlc(a)experient-inc.com.
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Forth 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 accor-
dance with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# 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