Registration

State of the State Registration

Registration Form Information of 2009 Conference:

Type of Registration	Price	Deadline
Advanced Individual	$125.00	3/13/09
Advanced Individual with Generic CEU's	$150.00	3/13/09
Advanced Individual with Social Work CEU's	$150.00	3/13/09
Regular Individual	$150.00	After 3/13/09
Regular Individual with Generic CEU's	$175.00	After 3/13/09
Regular Individual with Social Work CEU's	$175.00	After 3/13/09
Group (3 or more from same organization)	$125.00 per person	Anytime
Group with Generic CEU's	$150.00 per person	Anytime
Group with Social Work CEU's	$150.00 per person	Anytime
Retiree	$75.00	Anytime
Retiree with Generic CEU's	$100.00	Anytime
Retiree with Social Work CEU's	$100.00	Anytime
Full-time Student	$75.00	Anytime
Full-time Student with Generic CEU's	$100.00	Anytime
Full-time Student with Social Work CEU's	$100.00	Anytime
Luncheon Only	$35.00	Anytime
**Cancellation notification REQUIRED by 3/16/09. No refunds after that date!

A copy of the returned webpage upon submitting the form should accompany purchase orders. Invoices will not be sent as registration form serves as invoice. NOTE: Registration confirmed upon receipt of payment.
Checks Payable to: BGSU/SOS/OED
Download, fill out and mail the Registration Form with your payments c/o Marshall Rose, Office of Equity and Diversity, BGSU, Bowling Green, Ohio 43403.

Mr. Ms. Dr. Other

Job Title

First Name: (Please submit a separate online form for each member of your organization, including Group Registrations.)

Last Name:

Company/Organization:

Mailing Address:

Telephone:

Fax:

E-mail Address:

Special Consideration (e.g. Generic CEU's, Social Work CEU's, Accommodations, Special Diet, etc.)

NOTE: Registration confirmed upon receipt of payment.

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