Www.ohioschoolboards.org
Registration Form
2014 OSBA Capital Conference
Nov. 9, 10, 11 & 12 — Columbus, Ohio
School district County
Address
City
ZIP
Contact person Daytime phone
Email (required to receive housing link and code)
___Check here if any registrants have a disability that requires special services. Attach a written description of needs.
| | |
|1. Name |Additional fee |
|Title |Early Bird Workshop |
|Address |OSBA Black Caucus dinner |
|Name of attending spouse Other |Sun., Nov. 9 |
|district, if applicable |Conference luncheon |
| |Mon., Nov. 10 |
| |Conference luncheon |
| |Tue., Nov. 11 |
| | |
| | |
|2. Name |Additional fee |
|Title |Early Bird Workshop |
|Address |OSBA Black Caucus dinner |
|Name of attending spouse Other |Sun., Nov. 9 |
|district, if applicable |Conference luncheon |
| |Mon., Nov. 10 |
| |Conference luncheon |
| |Tue., Nov. 11 |
| | |
| |Additional fee |
|3. Name |Early Bird Workshop |
|Title |OSBA Black Caucus dinner |
|Address |Sun., Nov. 9 |
|Name of attending spouse Other |Conference luncheon |
|district, if applicable |Mon., Nov. 10 |
| |Conference luncheon |
| |Tue., Nov. 11 |
| | |
| | |
|4. Name |Additional fee |
|Title |Early Bird Workshop |
|Address |OSBA Black Caucus dinner |
|Name of attending spouse Other |Sun., Nov. 9 |
|district, if applicable |Conference luncheon |
| |Mon., Nov. 10 |
| |Conference luncheon |
| |Tue., Nov. 11 |
| | |
| | |
|5. Name |Additional fee |
|Title |Early Bird Workshop |
|Address |OSBA Black Caucus dinner |
|Name of attending spouse Other |Sun., Nov. 9 |
|district, if applicable |Conference luncheon |
| |Mon., Nov. 10 |
| |Conference luncheon |
| |Tue., Nov. 11 |
| | |
|6. Name |Additional fee |
|Title |Early Bird Workshop |
|Address |OSBA Black Caucus dinner |
|Name of attending spouse Other district,|Sun., Nov. 9 |
|if applicable |Conference luncheon |
| |Mon., Nov. 10 |
| |Conference luncheon |
| |Tue., Nov. 11 |
| | |
| | |
|7. Name |Additional fee |
|Title |Early Bird Workshop |
|Address |OSBA Black Caucus dinner |
|Name of attending spouse Other district,|Sun., Nov. 9 |
|if applicable |Conference luncheon |
| |Mon., Nov. 10 |
| |Conference luncheon |
| |Tue., Nov. 11 |
| | |
| | |
|8. Name |Additional fee |
|Title |Early Bird Workshop |
|Address |OSBA Black Caucus dinner |
|Name of attending spouse Other district,|Sun., Nov. 9 |
|if applicable |Conference luncheon |
| |Mon., Nov. 10 |
| |Conference luncheon |
| |Tue., Nov. 11 |
| | |
| | |
|9. Name |Additional fee |
|Title |Early Bird Workshop |
|Address |OSBA Black Caucus dinner |
|Name of attending spouse Other district,|Sun., Nov. 9 |
|if applicable |Conference luncheon |
| |Mon., Nov. 10 |
| |Conference luncheon |
| |Tue., Nov. 11 |
| | |
| | |
|10. Name |Additional fee |
|Title |Early Bird Workshop |
|Address |OSBA Black Caucus dinner |
|Name of attending spouse Other district,|Sun., Nov. 9 |
|if applicable |Conference luncheon |
| |Mon., Nov. 10 |
| |Conference luncheon |
| |Tue., Nov. 11 |
Please mail with check payable to: Ohio School Boards Association, 8050 N. High St., Ste. 100, Columbus, OH 43235-6481; or fax with purchase order to (614) 540-3299.
Total Remittance $
-----------------------
|PLEASE COMPLETE BEFORE MAILING |Number |Amount |
|___ OSBA member districts, 1-6 registrations — $275 each ........................................................ | |$ |
|___OSBA member districts, more than 6 registrations — $1,700 flat fee .................................... | |$ |
|___OCSBA member — $275 each .............................................................................................. | |$ |
|___Students, sustaining members and government employees — $60 each .................................. | |$ |
|___Retired administrators — $60 (not currently affiliated with public schools) ............................ | |$ |
|___Non-school district registrations — $550 each ........................................................................ | |$ |
|___Spouses — conference registration at no charge....................................................................... | |Comp. |
|___Early Bird Workshop: Simon T. Bailey (Sunday, Nov. 9) — $95 ............................................ | |$ |
|___OSBA Black Caucus dinner (Sunday, Nov. 9) — $70.................................................................... | |$ |
|___Conference luncheon: Dr. Tracey Wilen (Monday, Nov. 10) — $55 ..................................... | |$ |
|___Conference luncheon: Katie Smith (Tuesday, Nov. 11) — $55............................................... | |$ |
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