Last Name: ______________________
2017 AERO One-Day Division Day
Conference
Unique Divisions – One Goal
Friday, October 27, 2017
The Ohio State School for the Blind
5220 N. High St.
Columbus, Ohio 43214
(614) 752-1359
Registration Form
Name: __________________________________________________________
Organization/Employer: ____________________________________________
Address: ________________________________________________________
City: ____________________________ State: _________
Zip: _________
Phone: _______________________________________________
E-Mail: _______________________________________________
AER Membership Number: _______________________________
Last Name: ______________________
Registration fee includes all sessions - with ACVREP credit, morning coffee, lunch, afternoon
snack, door prizes and CEUs.
Please Complete:
EARLY BIRD REGISTRATION – Postmarked by September 1, 2017
_____
AER Member - $65.00
Early Bird Registration Postmarked by September 1, 2017
_____
Non-AER Member - $100.00
Early Bird Registration Postmarked by September 1, 2017
REGULAR REGISTRATION RATE - Postmarked by October 10, 2017
______
AER Member - $75.00
Regular Registration Postmarked by October 10, 2017
_____
Non-AER Member – $100.00
Regular Registration Postmarked by October 10, 2017
LATE REGISTRATION RATE – Postmarked after October 10, 2017/ or on-site*
_____
AER Member – $100.00
Late Registration Postmarked after October 10, 2017
_____
Non-AER Member – $100.00
Late Registration Postmarked after October 10, 2017
STUDENT RATE – Postmarked by October 10, 2017
*Student ID or additional form of proof is required
_____
Student - $45.00
*ON-SITE REGISTRATION DOES NOT GUARANTEE FOOD.
Only a limited number of on-site registration seats are available.
Personalized meal selection is not available for on-site registration.
Last Name: ______________________
Conference Materials:
I prefer:
_____
Braille Handouts
_____
Large Print Handouts
_____
Regular Print Handouts
Lunch Meal Selection:
If you require additional dietary requirements – such as Vegan or Gluten-Free choices, please
check “other” and identify your dietary needs.
_____
Turkey and Cheese Sandwich
_____
Ham and Cheese Sandwich
_____
Roast Beef and Cheese Sandwich
_____
Tuna Sandwich
_____
Vegetarian Sandwich
_____
Other: (please specify)
_________________________________________
Please mail this completed form and your check payable to “AERO” to:
Dr. Tiffany Wild
The Ohio State University
222 Ramseyer Hall
29 W. Woodruff Ave.
Columbus, Ohio 43210
Last Name: ______________________
Please note:
Registration must be postmarked by September 1, 2017 to participate in the
Early Bird Registration program!
Refund Policy
Cancellation requests must be submitted in writing by October 1, 2017.
The registration fee will be refunded less a $10.00 processing fee.
After October 1st, the refund will be 50% of the registration fee.