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) — $55............................................... | |$ |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download