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Registration and Program Information CHAPTER CONFERENCES


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2012 CHAPTER CONFERENCES REGISTRATION FORM


INSTRUCTIONS:


1. Please use one form per person. Make copies for additional participants. 2. Please type or print all information. 3. If you would like to become an OLC individual member and take advantage of the member rate for the chapter conferences, complete the Membership Application on page 4 and return it with your registration form. 4. Please refer to “Registration Guidelines” on Page 2 to see OLC’s cancellation policy.


INFORMATION: 5. Name: ________________________________________________________________________________________________________ Membership #:______________________________________________ Daytime Phone:________________________________________ Library/Institution: ________________________________________________________________________________________________ Address:____________________________________________________City/State/Zip: ________________________________________ E-mail: ________________________________________________________________________________________________________


OLC believes that we can better plan future Chapter Conferences if we know a bit more about the people who attend current programs. Please tell us a bit about yourself by completing the simple profile form below. First, choose the position that best reflects your current role at the library, then, generally speaking, indicate the size of your library, and finally, state the total number of years you’ve worked in a library even if some of those years may have been spent in positions different from your current role.


Current Role Director


Administrator/Management Information Technology Technical Services Children’s Services YA Services


Outreach/Special Services/Marketing Reference Services Adult Services Support Staff Other


REGISTRATION TYPE: (Check all that apply) 6.


OLC Individual Member FEES:


7. Registration Fees: (See Number 4 of Registration Guidelines.) Enter the appropriate amount on the line of each event you will attend. Member $80.00 $35.00


Chapter Conference Trustee Dinner


Conference Date


March 21 – Northeast Chapter March 28 – Southwest Chapter


April 5 – Eastern Chapter (dinner only) April 13 – Northwest Chapter


Non-Member $125.00 $35.00


Chapter Conference


$____________________ $____________________ N/A


April 18 – Southern Chapter (dinner only) April 26 – North Chapter


Vegetarian lunch required


$____________________ N/A


$____________________ May 3 – Central/Southeast Chapters $____________________


PAYMENT OPTIONS: 8. Check made payable to OLC enclosed: OR Please charge to:


Visa MC


Student $40.00 $35.00


Speaker $0.00 N/A


Trustee Dinner (night before each conf.)


$____________________ $____________________ $____________________ $____________________ $____________________ $____________________ $____________________


$____________________ $____________________ $____________________ $____________________ $____________________ $____________________ $____________________


Total Amount Due $____________________ Special dietary requirements Please explain: __________________________________________________ Amount Due Non-Member Speaker – Program Title______________________________________________________ Size of Library (Sm/Med/Lg) Total number of years you have worked in a library


Mail the completed registration form to Ohio Library Council, 1105 Schrock Road, Suite 440, Columbus, OH 43229 or fax it to (614) 410-8098 with complete credit card information. Online registration is also available by visiting our website at www.olc.org. To avoid double billing do not follow a faxed credit card registration or an online registration with paper registration.


AmEx or


Purchase Order


Card/P.O. Number: _______________________________________ Expiration:______________ 3 or 4 digit security code: ______________ Authorized Signature:______________________________________________________________________________________________


OLC Individual Membership Application on the reverse side of this Registration Form.


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