Please fill out the following registration form to register. Don't leave any blanks empty.
     
Conference Information:

EDUC 689, EDUC 692, EDUC 694

  Place the course number(s) in the blank you plan to take.
Today's Date
 

Place Month and Day in the blank

     
Registrant Information:
Name:
 
Street Address:
  Use your home address - not school address
City:
 
State:
 
Zip:
 
Have you ever taken one of our courses before?
 

Respond with either: Returnee or First Timer

Cell Phone
  Please format as: 555-555-5555
Indicate The Site You Plan To Attend:
  Place Sandusky or Cincinnati in the blank
Personal Email Address- Not School Email Address:
  This is required for confirmation
     
School & Professional Information About Your Position
 
Will you have others from your district attending the class?
  Yes or No
Are you taking the workshop for license renewal, salary increment, or PD?
  Answer "License Renewal, Salary Increment. or PD
Name Of Your School
  Identify the name of your school
Street Address
  List the street address of your school
City, State, and Zip Code
  City, State, and Zip Code for your school address
Your School Email address
  Provide your school email address
Your Position
  Teacher - Counselor - Administrator
Grade Level
  List the grade level(s) of students you serve
Subject Area
  List the subject area(s) you teach
Type of School
  Elementary, Middle, or High School
     
Credit Cards are not accepted.
Your deposit on Day 1 of class must be paid in cash.  No checks and no credit cards accepted.
    Credit Cards Are Not Accepted
  Cash Deposit Due on February 26th
 
$ 225 Remaining Balance Paid To:
  Oakland City University
  138 N. Lucretia Street
  Oakland City, Indiana
 
  When information is complete, click on Register.
     
   
 
 

© Copyright 2003 , Bill Denney Consulting, Inc. All Rights Reserved. Contact Bill Denney.