NYS Town Clerks Association
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NEW YORK STATE TOWN CLERKS ASSOCIATION 2006 CONFERENCE REGISTRATION FORM
Rochester, New York April 29- May 2, 2007
INSTRUCTIONS:
1. ONLY ~ REGISTRANT PER FORM (PLEASE COPY FOR ADDmONAL REGISTRANTS)
2. COMPLETE ALL AREAS. (THIS INFORMA TION IS IMPORTANT).
3. SUBMIT HOTEL ACCOMMODATION REGISTRATION FORM TO Hyatt Regency Rochester, 125 East Main St., Rochester, NY 14604
4. SUBMIT CONFERENCE REGISTRATION FORM AND CHECK PAYABLE TO NYSTCA TO:
Nancy Brooks, Lockport Town Clerk, 6560 Dysinger Rd., Lockport, NY 14094
LAST NAME /Y\ A ~'il{;.RSot1 FIRST NAME """J"'OHYl MI (l~
MAILING ADDRESS J-O II1lbME.6VSt( Rr-" CITY WJ\..PPIN66RJ M-t.U NYZIPCODE 18.510
TOWN (A)A.PP(lJ(9E~ COUNTY hvTeJ,(eSS' PHONE#{fL{~)J.q7~5'7'11 FAX (S-I.{r;;:)d.-cr<6-1'I7&
FIRST NAME FOR BADGE (nickname) ('J-t R I S E-MAIL: (.mA<STE:R.S.ON@Tawnoi=Wf1.PPlrJ6ER.US
YOUR TITLE: CLERK / DEPlITY EXHIBITOR STATE AGENCY SPEAKER GUEST
ASSOCIATE MEMBER
CHECK ALL THAT APPLY: NEW CLERK
FIRST CONFERENCE
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NEW YORK STATE TOWN CLERK ASSOCIATION CONFERENCE - EARLY REGISTRATION DEADLINE 3/15/07
ALL REGISTRANTS MUST CHOOSE ONE
MEMBER CLERK/DEPlITY $ 60.00 each ...................................................................................... $
NON-MEMBER CLERK $110.00 each ..................................................................................... $
NON MEMBER
$150.00 each........................... ..................... ...................................... $
ONE DAY REGISTRATION MEMBER $30.00 NON MEMBER $80.00..........................................$
LATE REGISTRATION (AFTER 3/15/2007) add $25.00........................................................... $
COMPLIMENTARY REGISTRATION:
NY State Representatives, Exhibitors, Associate Members, Spouses/Guest......$
GUEST NAME(s): (Those not attending seminars.)
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REMIT CHECK PAYABLE TO NYSTCA (please total ALL applicable lines above) ....................................$ (00, ~
NYSTCA, % Nancy Brooks, Lockport Town Clerk, 6560 Dysinger Rd., Lockport, NY 14094 **$15.00 charged for cancellations after 4/14/06.
Cancellation Refunds must be requested in writing by May 15, 2007 ./'
PLEASE COMPLETE ALL INFORMATION: HOTEL GUEST V OR COMMUTER
DEPARTURE DAY & DATE: -.2/ 0 '107 lues
CHECK OUT TIME IS NOON
MEAL (S) NOT INCLUDED IN HOTEL PACKAGE
MONDAY NIGHT DINNER INCLUDES TRANSPORTATION $50.00 ......................................... $
COMMUTERS OR THOSE WISHING TO PURCHASE ADDITIONAL MEALS
Sun.
Mixer @ $38.00 each ............................................................................................... $
Breakfast_ @ $18.00 each Lunch_@ $24.00 each ................................................... $
Breakfast_ @ $18.00 each Lunch _@ $24.00 each Banquet_@ $46.00 each.... $
Mon.
Tues.
Wed.
Breakfast_ @ $18.00 each Lunch _@ $24.00 each ................................................. $
_DOUBLE
~
_TRIPLE
ACCOMMODATIONS DESIRED (check one):
IF SHARING ROOM INDICATE NAME(s) OF ROOMMATE(s)
~06C?2
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NC
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_QUAD
PLEASE NOTE ANY SPECIAL REQUIREMENTS (i.e. handicapped accessibility, non-smoking, dietary restrictions):
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MAIL CONFERENCE REGISTRATION SHEET/CHECK PAYABLE TO NYSTCA BY 3/15/2007:
NYSTCA, Nancy Brooks, Lockport Town Clerk, 6560 Dysinger Rd., Lockport, NY 14094 PHONE: 716-439-9524; FAX: 716-438-5221
e-mail: town_c1erk@elockport.com
MAIL HOTEL SHEET BY 4/6/2007: Hyatt Regency Rochester Reservations, 125 East Main St., Rochester, NY 14604
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Town of Wappinger
20 MIDDLEBUSH ROAD
WAPPINGER FALLS, NY 12590
PURCHASE ORDER & VOUCHER
Department:
CLAIMANT'S
NAMEAND
ADDRESS
NYSTCA
c/o Nancy Brooks, Lockport Town Clerk
6560 Dysinger Road, Lockport, NY 14094
Due on Receipt
TERMS
Purchase
Ordor No.
DO NOT WRITE IN THIS BOX
Date VouCher Received
FUND - APPROPRIATION AMOUNT
TOTAL $0 00
ABSTRACT NO. I
VENDOR'S
REFNO.
DATES INV# Quantity DESCRIPTION OF MATERIALS OR SERVICES UNIT PRICE AMOUNT
03/14/07 1.00 NYSTCA Conference Registration Fee $60 00 $60 00
TOTAL $60.00
John C. Masterson 6000
I. certify that the above account In the amount of $ .
IS true and correct; thaI the items, services. and disbursements charged were rendered to or for the municipality on the dates stated; that no part has been paid or satisfied; that taxes, from which the
municipality Is exempted, are not Included: and that the amount claimed Is actually due
3/1~)bl
DATE
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SIG :A.TURE
(SPACE BELOW FOR MUNICIPAL USE)
TITLE
Town Clerk
DEPARTMENT APPROVAL
The above services or materials were rendered or
furnished to the municipality on the dates stated and the
charges are correct
DATE
AUTHORIZED OFFICIAL
APPROVAL FOR PAYMENT
This claim Is approved paid from the appropriations Indicated above
COMPTROLLER
DATE
A. ., .
Town of Wappinger
20 MIDDLEBUSH ROAD
WAPPINGER FALLS, NY 12590
PURCHASE ORDER & VOUCHER
Department:
CLAIMANT'S
NAMEAND
ADDRESS
NYSTCA
c/o Nancy Brooks, Lockport Town Clerk
6560 Dysinger Road, Lockport, NY 14094
Due on Receipt
TERMS
Purchase
Order No.
DO NOT WRITE IN THIS BOX
Dale Voucher Received
FUND - APPROPRIATION AMOUNT
TOTAL $0 00
ABSTRACT NO. I
VENDOR'S
REFNO.
DATES INV# Quantity DESCRIPTION OF MATERIALS OR SERVICES UNIT PRICE AMOUNT
03/14/07 1.00 NYSTCA Conference Registration Fee $60 00 $60 00
03/14/07 1 Late Fee $25 00 $25 00
TOTAL $85.00
John C. Masterson 85 00
1, certify that the above account in the amount of $ .
15 true and correct; thai the Items, services, and disbursements charged were rendered to or for the munlclpallly on the dates stated; that no part has been paid or satisfied; that taxes. from which the
municipality is exempted. are not included: and that the amount claimed is actually due
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DATE
'f
c:~~
IGNATURE
(SPACE BELOW FOR MUNICIPAL USE)
Town Clerk
TITLE
DEPARTMENT APPROVAL
The above services or materials were rendered or
furnished to the municipality on the dates stated and the
charges are correct
DATE
AUTHORIZED OFFICIAL
APPROVAL FOR PAYMENT
This claim Is approved paid from the appropriations Indicated above
COMPTROLLER
DATE