Conference Invoice Registration Form

Please complete one registration form for each attendee.

Early-Bird Pricing:

OCDCA Member: $190
OCDCA - Additional Staff Member: $110

Non-Member: $240
Non-Member - Additional Staff Member: $135

Student or Non-OCDCA AmeriCorps Member: $100
Thursday Lunch-Only: $50
Wednesday-Only: Free

Name *
Name
Address *
Address
Contact Phone *
Contact Phone
Yes, I plan on attending the following meals: *
Please check each meal you intend to attend. Note, if you selected "Wednesday-Only Registration," please select NA.
Yes, I plan on attending the following Wednesday activities: *
Please check whether you will attend either Wednesday event.
Please let us know if you have any other dietary restrictions (allergies, gluten intolerance, etc.)
ADA Needs
Do you have any special needs addressed by the ADA? If so, please describe in the box below.
Please describe your ADA needs
Additional Registrations *
If you are registering more than one person, check the appropriate box and complete your registration. To register the additional attendees, please complete the invoice registration form for each attendee: https://www.ohiocdc.org/conference-invoice-form, which can also be found via the Register by Invoice button on the conference page.
Please enter a discount code if you have one.