FEBRUARY 2 - 3, 2010 (Registration: 8:00 – 9:00; Conference: 9:00 – 4:15)

BASIC INFORMATION

First Name:  Last Name: School/Agency:

Address:  City State Zip

Work Phone: Home Phone:  Email:

CEC Membership #: Special Accommodations:

CONFERENCE FEE

Which day's conference will you attend? Full Conference (2 full days) Tuesday Only (1 full day) Wednesday Only (1 full day)

* Presenters may attend the full conference or only the day presenting at a reduced rate.

Are you filling out this form before 4:00pm Jan. 25, 2010? Yes No

YOUR CONFRENCE FEE IS:

LUNCH

I will be eating lunch at the conference on Both days Tuesday only Wednesday only Neither day

Special dietary request (We will do our best to accommodate your identified needs.):
Nothing special
Vegetarian
Other: Please specify

METHOD OF PAYMENT (Make payable to OKCEC.)

Purchase Order #: will be mailed. (OKCEC FEDERAL ID # 73-1208142)
Purchase Order #: that will be presented at conference.
Personal check #: will be mailed.
Pay online via PayPal