Registration Form for the
 Oklahoma Division of Student Assistance
Annual Conference
March 10-12, 2010

"The Audacity to Care"
Skirvin Hilton Hotel, OKC
Single Rate-$118
Double Rate-$118
To make a reservation please click on this direct STARlink
Link to go live ASAP

Please register all program staff who will be attending the conference.
If you are paying by Purchase Order, be sure to include your PO Number when you register!

1. Name:    Title/Position:  Program Name:
    How many years have you been working with TRiO?:    LPC: Yes No   NCC:  Yes No

     Will this staff member be retiring this year? No Yes
 

2. Name:    Title/Position:  Program Name:
    How many years have you been working with TRiO?:    LPC: Yes No   NCC:  Yes No

     Will this staff member be retiring this year? No Yes
 

3. Name:    Title/Position:  Program Name:
  How many years have you been working with TRiO?:   LPC: Yes No   NCC:  Yes No
     Will this staff member be retiring this year? No Yes

4. Name:    Title/Position:  Program Name:
    How many years have you been working with TRiO?:   LPC: Yes No   NCC:  Yes No
     Will this staff member be retiring this year? No Yes

5. Name:    Title/Position:  Program Name:
      How many years have you been working with TRiO?:     LPC: Yes No   NCC:  Yes No
    Will this staff member be retiring this year? No Yes

6. Name:    Title/Position:  Program Name:
      How many years have you been working with TRiO?:     LPC: Yes No   NCC:  Yes No
     Will this staff member be retiring this year? No Yes

7. Name:    Title/Position:  Program Name:
      How many years have you been working with TRiO?:     LPC: Yes No   NCC:  Yes No
     Will this staff member be retiring this year? No Yes

Contact Name: 
Institution: 
Address: 
City:    State:    Zip: 
Telephone:    Fax: 
E-Mail:    Program Website: 

Please mark with which program you are affiliated:  (To mark more than one, hold down the alt key.)

  EOC ETS McNair SSS UB UBMS VUB
 

 Early Bird Registration for current ODSA MEMBERS (deadline 2/11/2010)- $140.00/person

Registration for current ODSA MEMBERS - $170.00/person

Registration for Non-Members  - $200.00/person

Method of Payment: 
Check  Purchase Order    PO# 

ODSA FEI# 73-1086249

Treasurer: Tony Lehrling
                             

SPECIAL SERVICES REQUIRED:  Please give a brief description of your needs (vegetarian meals,

                                                    special assistance, special room accommodations, etc.)

*REFUND POLICY

Refunds of registration fees will be considered only upon written request. For a full refund requests must be received or postmarked thirty days before the conference start date. For a 50% refund, requests must be received or postmarked ten days before the conference start date. No refunds will be issued after that date.

Membership dues of $30 will be accepted on site.  Please remember that dues cannot be paid from federal funds. 

For questions regarding on-line registration, please contact Jessica McKelvey at jessicam@cameron.edu, or 580-581-2791
For questions regarding payment, please contact Tony Lehrling at tlherling@se.edu, or
For questions regarding conference information, please contact Loral Henck at lhenck@gmail.com, or