Event Registration

Fields marked with an * are required.

*First Name
*Last Name
*Email
*Phone
Address
City
State
Zip Code
Employer
Position
Interest Group - please indicate all that apply
Educator		Family
Medical Providor		Student
Social Service Providor		Other:
General Registration - please check one
Day 1 and Day 2		March 3 and March 4, 2010	$150
Day 1 only		March 3, 2010	$100
Day 2 only		March 4, 2010	$100
Student Rate  - * no Student Rate 2-day package*
Day 1		March 3, 2010	$50
Day 2		March 4, 2010	$50
School Name (required)
Financial Assistance A limited number of scholarships to cover conference registration are available. For information please contact Debbie Coehlo at debbie.coehlo@osucascades.edu
Payment Information Due to limited space your Check, PO# or Credit Card information must be received to complete your registration. Make checks & POs payable to HDESD. Please choose your desired payment type below:
Check		Check # Mail to: Ed+Med, 8437 SW 77th, Redmond OR 97756
Purchase Order		PO # (Required) Agency
Cedit Card		We currently are not able to process credit card payments on-line. If you choose to pay via credit card our staff will contact you directly to complete the secure registration payment. Most major credit cards accepted.
Cancellation Policy: Cancellation received 30 days prior to conference – Registration refunded less 10%

Privacy - We promise your personal information will only be used to communicate with you regarding the conference. Your information will not be shared.

A print version of our registration form you can be downloaded here:
» Ed+Med Registration Print Form (Word doc).