Oregon Association of Student Councils

Registration Form

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 25th deadline $18.00 per person if more than 25 participants (members only) by January 25th deadline $27.00 per person if registered after January 25th deadline	$27.00 per person if registered by January 25th deadline $32.00 per person if registered after January 25th 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 1st LDS Church 850 SW 11th St. Hermiston, OR 97838	Wednesday, February 2nd Redmond High School 675 SW Rimrock Dr. Redmond, OR 97756
Thursday, February 3rd Mountain View MS 2015 Emery Dr. Newberg, OR 97132 (Middle School only)	Friday, February 4th Century High School 2000 Century Blvd. Hillsboro, OR 97123 (High School only)

2010-11 Member Dues @ $55.00 (please submit membership form)

Number of Students @ $ =

Number of Adults @ $ =

TOTAL AMOUNT DUE:

Sending Payment

Bill School, PO#

Please remember NO ON-SITE REGISTRATIONS!

Deadline for “early bird” registration is Tuesday, January 25, 2011. The price goes up $5.00 per person more after the 25th.

A $5.00 per person fee for no-shows will be assessed, unless our office is notified by January 27, 2011

For additions or changes in your numbers, please contact Betsy Brawner: 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 Sara Nilles, Program Director
or call 503-480-7206.