NYSTCA
Town of Wappinger
20 MIDDLEBUSH ROAD
WAPPINGER FALLS, NY 12590
PURCHASE ORDER & VOUCHER
Department:
CLAIMANT'S
NAMEAND
ADDRESS
NYSTCAc/o Georgette Davis, Town Clerk
60 Main St. Rm 3
Massena, NY 13662
Due on Receipt
TERMS
~= IU
DO NOT WRITE IN THIS BOX
Date Voucher ReceIved
FUND - APPROPRIATION AMOUNT
ILIff). YV~H
TOTAL $0 00
ABSTRACT NO. I
VENDDR'S
REFNO.
DATES INV# Quantity DESCRIPTION OF MATERIALS OR SERVICES' UNIT PRICE AMOUNT
03/01/2012 1.00 NY Town Clerks Association Conference registration $150 00 $150 00
TOTAL $150.00
Christine Fulton 15000
I, certify that the above account In the amount of $ .
is true and correct; that the items, services, and disbursements charged were rendered to or for the municlpal~y on the dates stated; that no part has been paid or satisfied; that taxes, from which the
:~:~-~'-~~'''~-2~ TownCled
DATE ATURE TITLE
(SPACEBELOWF0RMUNICIPAL USE)
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
DATE
COMPTROLLER
..
..
NEW YORK STATE TOWN CLERKS ASSOCIAnON 2012 rCONFERENCE REGISTRAnON FORM]
Saratoga Hilton, Saratoga Springs, NY April 22 - April 25, 2012
INSTRUcnONS:
1. COMPLETE ALL AREAS. THIS INFORMATION IS IMPORTANT FOR CONFIRMATION.
2. ONLY Qt!E REGISTRANT PER FORM (PLEASE COPY FOR ADDmONAL REGISTRANTS)
3. {HOTEL ACCOMMODA rrON FORM & SALES TAX FORM} - MUST BE SUBMITTED DIRECTLY TO THE HOTEL.
4. SUBMIT {CONFERENCE REGISTRAnON FORM'}. AND CHECK PAYABLE TO NYSTCA before 3/21/2012. see below.
5. 25.00 charged for cancellation after 4/10/12
LAST NAMEJU l-\-c)r\ . FIRST NAME~ r) s+l0e..- MI
MAIUNG ADDRESS 'd 0 rn \ dd kllish fbtn l k.)AW~~\ 'SHy, ZIP } dOCJO
TOWN_WBpPcq/ COUNTY..D.t~~~ PHONEillJ5'oCf7-571IFAX 8<1~~ }LJ/~
FIRST NAME FOR BADGE (niCknamethVlsnf"t- email addressc..ruL-rOtJ~1DWnDP~I~l(J?US.
YOUR TITLE: CLERK./' DEPUTY EXHIBITOR S TATE AGENCY/SPEAKER GUEST
CHECK ALL THAT APPLY: NEW CLERK /' NEW DEPUTY__ FIRST CONFERENCE
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**ALL REGISTRANTS MUST CHOOSE ONE
MEMBER CLERK/DEPUTY $ 100.00 each................................................................................................ $
NON-MEMBER CLERK $150.00 each.................................................................................................$ I 50.. 00
NON MEMBER
$175.00 each...... ... ... .............. ...... .... ............ ..... ........ .................... .... ......... $
ONE DAY REGISTRATION MEMBER $65.00 NON MEMBER $125.00....................................................$
COMPUMENTARY REGISTRATION: NY State Representatives, Exhibitors, Spouses/Guest................. $ NC
LATE REGISTRATION ............. (AFTER 3/21/2012) ...................add $25.00....................................... $
o
GUEST NAME(s}: (Those not attending seminars.)
**OTHER EVENTS
. NOTARY CLASS for REGISTERED MEMBERS $50 .................................................................................$
NOTARY CLASS ONLY.....................$50.00 PLUS ONE DAY REGISTRATION FEE................................$
MONDAY NIGHT DINNER..............$60.00........................ ......................................................................$
**COMMUTERS AND ANYONE WISHING TO PURCHASE ADDITIONAL MEALS NOT INCLUDED IN HOTEL PACKAGE
Sun. Mixer _ @ $50.00 each...........................................................................................................$
Mon. Breakfast_ @ $25.00 ea. Lunch_@ $30.00 ea..........................................................$
Tues. Breakfast_ @ $25.00 ea. Lunch _@ $30.00 ea. Banquet_@ $55.00 ea......$
Wed. Breakfast_ @ $25.00 ea. Lunch _@ $30.00 each ...................................................$
. . ". . '.
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** HOTEL INFORMATION: CHECK ONE:
HOTEL GUEST
(buyi ngfl1E!~I~/h()tel ~p~ck~g_e)_
MANDATORY - PLEASE SPEQFY: ARRIVAL DATE:
(Sun is 4/22, Mon 4/23, Tues 4/24,Wed 4/25) CHECK IN TIME IS 4:00 PM
OR COMMUTER
_ (nE!ed.s to purc_~ase rnE!~lsor bllymeals for a. guests)
DEPARTURE DATE:
CHECK OUT TIME IS 11:00AM
PLEASE NOTE ANY SPECIAL DIETARY REQUIREMENTS OR SPECIFIC ALLERGIES TO FOOD:
**,.,AIL CONFERENCE REGISTRA770N FOR,., WrrH CHECK PA YABLE TO NYSTCA Note: Form should be faxed or
emailed immediately (townclerk@town.massena.nv.u!i!). Forward check ASAP - NYSTCA, c/o Georgette Davis, Town
Clerk 60 MAIN ST. RM.3, MASSENA, NY 13662, PHONE 315-769-5228, FAX 315-769-7957