Registration Form

High School Cohort

June 21-22, 2007

The Ohio Leadership Forum is pleased to convene the final meeting of its leadership cohort focused on high school reform. If you would like more information than is provided on these web pages, contact Matthew Getz at matthew@ohioleaders.org or (877-351-OHIO toll free).

If you prefer to print this form and fax in your completed copy, click here. Print and fill out the form, then fax it to Matthew Getz at 319-248-0222.

Registration Deadline

We must receive your registration by Friday, May 18, 2007.

Questions?

For questions about the meeting program, contact Bonnie McIntosh (bonnie@ohioleaders.org or 877-351-OHIO toll free).

For questions about registration or meeting logistics, contact Matthew Getz (matthew@ohioleaders.org or 877-351-OHIO toll free).

Registration Information

If you have registered for an Ohio Leadership Forum meeting previously, you may provide information only for the areas marked with "*". Registrants who have not previously registered for an Ohio Leadership Forum event must complete the entire form.

	* denotes 'required' information
Last Name :
First Name :
First Name for Name Badge :
Title :
Organization :
Street Address :
Street Address 2 :
City :
State (e.g. OH):
Zip :	-
Phone :	- - extension
Cell Phone :	- -
Fax :	- -
Email :	*
Retype Email :	*
Assistant's Name :
Assistant's Email Address :
Assistant's Phone Number :	- - extension
Emergency Contact Name :
Emergency Contact Day Phone :	- - extension
Emergency Contact Evening Phone :	- - extension
Special Dietary Needs :

Do you authorize the Ohio Leadership Forum to share your contact information (street address, phone and fax numbers and email address) with other members of the cohort for the purpose of informal ongoing networking among participants? *

Yes
No

Conference Meal Functions - All meals will be provided, beginning with breakfast on June 21 through breakfast on June 22. Please check the box(es) for the meal(s) you will attend. If you sign up for a meal and later your plans change, please contact Matthew Getz (mathew@ohioleaders.org or toll free at 877-351-OHIO toll free) so we may eliminate unnecessary expenditures. *

Breakfast, June 21

Lunch, June 21

Dinner, June 21

Breakfast, June 22

Because the June forum is at a retreat setting, a few participants are planning on bringing their spouses and children. Therefore, we would like to extend an invitation to your spouses, children or any other guests you might like to include to the Reception & Dinner on June 21^st, 2007 at the Cherry Valley Lodge starting at 6:00pm on the Lobby Patio. The meal will be a BBQ dinner. Weather permitting we will have outdoor games at the BBQ.

Please enter below the number of family members, if any, that will be accompanying you. Your own meal is covered by the Ohio Leadership Forum. The price for the dinner will be $28.95 per additional adult guest and $14.50 per child.

Dinner, June 21 additional meals

Questions or Comments?