PRE-REGISTRATION FORM

 

Please fill in this form completely. Your registration may not be processed if information is missing. Your registration will be complete upon receipt of your payment.

 

When you hit SEND, You might see either or both of these, it's O.K.

Name
Home Address
City, State, Zip
Home Phone
Home Email
Name of School or Organization
Work Address
City, State, Zip
Work Phone
Work Email
Please list any special accommodations you need
Conference Registration (Includes 2 Free Spring Webinars)
Oregon Resident - $65 conference "Membership" registration fee Out of State Registrant - $75 conference registration fee Retired Instructor - $40 conference "Membership" registration fee
Pre-Conference Workshops - choose one:
Traction Action - $75 fee (includes kit) Model Roadway - $75 fee (includes kit) Curriculum - $50 fee (includes CD) In Car Activities - $30 fee Driver Ed Program Coordinator - $30 fee Training Update (Pre 2004) - $30 fee
Late Registration Fee - add $15 (after September 15)
Payment Options
Check or Money Order (made payable to OTSEA) * Employer Purchase Order *
NOTE: Registrations received after September 15 will be assessed a $15 late registration fee.  Please include this amount in your payment.
* Please mail your check, money order or purchase order to:
Sharon Rothacker, OTSEA Treasurer, P.O. Box 1026, Winston, Oregon 97496