Date
Title First Name Last Name
Department: Name Tag:
Address: City: State: Zip:
Phone/V-Mail: Fax: Cell/Pager: E-Mail:
A $25 late fee will be added to the registration fee after July 23, 2008. If cancellation is required after this date, a $50 fee will be assessed.
Paying $150 for Conference Registration (includes DAO dues, registration packet, continental breakfast, banquet, brunch and (1) complimentary t-shirt with each paid registration.
Please check size needed: Small Medium Large X-Large 2-XL 3-XL (for 3XL you must order 30 days in advance)
SPOUSE REGISTRATION: Check box if Yes Cost: $75 (Includes registration packet, spouse reception, door prizes, educational sessions, banquet and brunch and (1)t-shirt with each paid registration)
Spouse full name:
Spouse t-shirt size:
IF CHILDREN ARE ATTENDING:
Number of Children Attending
Please mark the ages of each child attending: Infant 1yr 2yr 3yr 4yr 5yr 6yr 7yr 8yr 9yr 10yr 11yr 12yr
Enter number attending: Guest/Spouse Banquet @ $25 each
Child Banquet @ $20 each (12 and under)
Guest/Spouse Brunch @ $25 each
Child Brunch @ $20 each (12 and under)
D.A.R.E. RX/OTC DRUB PROGRAM & COMMUNITY PROGRAM TRAINING:
Monday (pm) or
Thursday (pm)
COMMENTS:
FORM OF PAYMENT:
Check box if you need an invoice:
If using a P.O.#, please enter number here:
If you are sending in a check, please print this online submit form (BEFORE SUBMITTING ) and attach it to your check. Make checks payable to DARE Association of Ohio and mail to:
DARE Association of Ohio 6277 Riverside Dr., Ste. 2N Dublin, OH 43017 ATTN: Pamela Johnson
HOTEL ACCOMODATIONS:
Room reservations must be made prior to JUNE 23, 2008 at the Kalahari Resort, 7000 Kalahari Drive, Sandusky, OH 44870, Reservations: (877) 525-2427, Press 2. Rooms may not be available after this date. The Group rate is $114 plus tax. The Hut Rooms (2 Queen Beds) or NOMAD Rooms (2 Queen Beds, + Sleeper Sofa) are available for $154 plus tax. All rooms receive 4 Water Park Passes and contain a refrigerator and microwave. Rooms will be ready for check-in at 3:00 pm. You must arrive by 3:00 p.m. to guarantee your reservation or guarantee with a credit card number or one night’s deposit 24 hours in advance. To receive tax-exempt benefits, the Officer must have the necessary paperwork/number with them, as well as pay the room account with an agency credit card or agency/city check. No personal checks accepted when receiving the tax-exempt benefit. Mention your tax-exempt status when making your room reservations.
