Ohio Statewide Summit 2019 Registration Form

 

Name:_______________________________________________________________      

Email: _______________________________________________________________________________

Phone: ____________________________       County of Residence:______________________________

Name of Local Group:_______________________________    Group Leader:______________________

Do you need a special diet?  __No   Yes:  ___Gluten free   ___Vegetarian   ___Vegan   __Other:

Activities & Accomplishments of you &/or your group last year:_________________________________

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Please list any members of your group who have prepared talks on topics of interest, or other contacts you know and what they speak about:____________________________________________________-

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Lunch will be provided during the meeting.  Please bring cash or check  for $18 to pay for lunch when you check in at the summit.

Please reply with an email containing this form or the info this form asks for by March 7, as we have to turn in lunch reservations by March 8, 2019.