OASC 2010 Winter Regional Leadership Workshops

Please fill out this form and submit it online or print it and send with payment to:

OASC
707 13th Street SE, Suite 100
Salem, OR, 97301-4035

School Name:
Billing Address:
City:
Zip:
Phone number with area code:
Name of Adult Contact:
E-mail Address:
Regional Workshop Fees: (Please note: the fee is the same for Advisors)

OASC Member Schools:	Non-Member Schools:
$22.00 per person if registered by January 27th deadline $18.00 per person if more than 25 participants (members only) by January 27th deadline $27.00 per person if registered after January 27th deadline	$27.00 per person if registered by January 27th deadline $32.00 per person if registered after January 27th deadline
A PURCHASE ORDER NUMBER BY THAT DATE WILL GURANTEE THE LOWER FEE!!

Please check appropriate box of funshop site you will be attending:
Tuesday, February 2nd LDS Church 850 SW 11th St. Hermiston	Wednesday, February 3rd Brown Middle School 1505 SW Cornelius Pass Rd. Hillsboro (Middle School Only)
Thursday, February 4th Fremont Middle School 850 W Keady Ct Roseburg	Friday, February 5th LIberty High School 21945 NW Wagon Way Hillsboro (High School Only)

2009-10 Member Dues @ $55.00 (please enclose membership form)

Number of Students @ $ =

Number of Adults @ $ =

TOTAL AMOUNT DUE:

Sending Payment

Bill School, PO#

Reminder: Adult supervision is mandatory -- one for every 15 students Some sites fill quickly and will be closed when they reach capacity. Please help us with our costs and planning by calling our office if you have a change in numbers - at least 4 days before your workshop. Otherwise your school will be assessed a $5.00 fee for each no-show. You may also email Betsy Brawner at betsy@cosa.k12.or.us

If you have a Purchase Order number and wish to be invoiced, you may submit this form online.
Security Code:
Please enter the security code you see above in this box:
If you would like to send payment with your membership form, please print this form and mail to the address below.
Mail to: OASC 707 13th Street SE, Suite 100 Salem, OR 97301-4035

Questions? Contact Nancy Moen, Program Director
or call 503-480-7206.