State of the State Registration

Registration Form Information of 2012 Conference

Type of Registration Price Deadline
Advanced Individual $125.00 3/16/12
Advanced Individual with Generic CEU's $150.00 3/16/12
Advanced Individual with Social Work CEU's $150.00 3/16/12
Regular Individual $150.00 Begin 3/17/12
Regular Individual with Generic CEU's $175.00 Begin 3/17/12
Regular Individual with Social Work CEU's $175.00 Begin 3/17/12
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
Dancing Wheels Presentation Only $10.00 Anytime
Display Table (includes Luncheon) $250.00 3/21/12
**Cancellation notification REQUIRED by 3/19/12.  No refunds after this date!   
  1. 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: Confirmation of registration will be sent upon receipt of registration form.
  2. Pay by credit card at 
  3. Make checks Payable to: BGSU/SOS/OMA

  4. Download, fill out and mail the Registration Form with your payments to:
    c/o Emily Monago, Ph.D., Office of Multicultural Affairs, 318 B Math Sciences Building, Bowling Green State University, Bowling Green, Ohio 43403.

Online Registration

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:


Mailing Address:



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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