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.

 

Please check the required fields

1. Name *
2. Email *
3. Home Address *
4. County (IMPORTANT) *
5. Home Phone *
6. Work Address *
7. Work Phone *
8. Work Email *
9. Accommodations  
10. Select Registration Level:
    Oregon Resident - $45 Out of state registrant - $75
11. Not Attending Traction For Action - $35 fee (includes kit) Traction For Action - $15 fee (kit not included) Traction For Action - Free (kit not included, Attending Saturday) Model Roadway - $35 fee (includes kit) Model Roadway - $15 fee (kit not included) Model Roadway - Free (kit not included, Attending Saturday) Skid Monster - $25 fee (BTW on Saturday, Court Print (copy) Required) First Aid/CPR (2 yr Cert) - $10 fee (Includes Certificate, No CE hrs) PowerPoint Presentation Tricks - Free (Attending Saturday, Laptop Required)
12. Check or Money Order (made payable to ODTSEA)
    Employer Purchase Order
    Paypal
    
13. Employer Name  
    If you checked "Employer PO" please enter Employer Name Here
14. Security Code: *
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NOTE: There will be a $25 late fee for those that register on-site at the conference.




To pay using Paypal, click here > > >

* Please mail your check, money order or purchase order to:

Sharon Rothacker, ODTSEA Treasurer, P.O. Box 1026, Winston, Oregon 97496

Sharon's email: Sharon@OTSEA.org
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