CONFERENCE REGISTRATION FORM

 

UUMADAOPS of Ohio 18th Annual State Conference  August 23-25, 2007

Four Easy Ways to Register:

By Mail:  Return your completed registration form and check, money order, purchase order, or credit card authorization made payable to: “UMADAOP State Conference”, Attn:  Sallie Mascus,  Registrar.    3021 Vernon Place, Suite Two, Cincinnati, Ohio 45219

 

By Phone:  (513) 541-7099 ext. 19

Call and charge the registration fee to your American Express, VISA, Discover, or Master Cared account or provide a purchase order number.  When you register by phone, please have registration form completed before you call so you have at hand all the information required by the registrar (Sallie Mascus).

 

By Fax:  (513) 541-0989

You can send your registration form by fax if you pay by credit card, provide a purchase order number.  Send to the Attn:  Conference Registrar, Sallie Mascus.

 

By Internet:

Click on:  www.umadaopsconference.org to complete the Registration process.  Payment must be made by credit card.

 

 

Name:                                                                      Social Security No.:

Agency/Organization:

 

Address:                                                                City:                                State:                             Zip:

 

Phone:                                Fax:                                       Email address:

 

 

 

REGISTRATION FEES

ð Early Bird $225 Includes:  conference souvenirs and access to all events   ð Regular, after July 15, 2007, $275

ð SPECIAL:  Register 3 or more participants @$200

ð College Students:  $150 – Includes:  conference souvenirs and access to all events (Must be registered student, current ID required)

ð Senior Citizens:  $100 – Includes:  conference souvenirs and access to all events – (62 and Older)

ð One day Registration:  $125 (Includes luncheon and conference souvenirs)

ð Youth Leadership Team participants: $50 per youth

ð Saturday Youth Explosion Only: $25 per youth

$50.00 Cancellation Fee for Processing & Handling after July 1, 2007.

 

SPECIAL NEEDS

                 ð Vegetarian Meals                 ð Hearing Impaired

                 ð Vegan Meals                        ð Wheelchair Access

                 ð  Other ___________________

 

METHOD OF PAYMENT

__ CHECK ENCLOSED. MADE PAYABLE TO: UMADAOP STATE CONFERENCE

__ PURCHASE ORDER (NOT accepted after June 15, 2007)

__ MASTERCARD/VISA/DISCOVER

 

 

CREDIT CARD NUMBER:  ________________________________________                   Text Box: NO REFUNDS AFTER July 15, 2007

SIGNATURE:  ___________________________________  EXP DATE _____