You are registering for the Promotion in Extension Workshop

Wednesday, January 16, 2013
8:30 am to 4:00 pm
Agricultural Administration Building Auditorium
2120 Fyffe Road
Columbus, OH 43210


General Agenda:
8:30 Registration Begins
9:00 Welcome
9:25 Understanding the Vita Review Process & Documentation
12:15 Lunch Provided
1:00 Round Table Discussions
4:00 Adjourn

Registration Fee: $25 (Covers Lunch & Breaks)

Deadline to register is 5:00p.m. Wednesday, January 9, 2013.
Please do not use a phone or ipad to register as you need to PRINT this page.

(see payment documentation options A and B below)

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* 1. Please Complete the following:

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* 2. I am paying by...

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* 3. REQUIRED Chartfield Information:

ACCOUNT # 64414

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* 4. OPTIONAL Chartfield Information:

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* 5. Authorizing Signature: (Please type the name here and then follow instructions for Option A below)

OPTION A:
  1. Fill out the questions above. 
  2. PRINT THIS PAGE!
  3. Obtain original "Authorizing Signature" and give to the person who reconciles your e-reports
  4. Click the NEXT button at the bottom of this page. You are NOT registered until you click SUBMIT on the NEXT page of the survey!

OPTION B:

  1. Fill out questions #1 & #2 above and PRINT 2 COPIES OF THIS PAGE (one for your records and one to submit with check).
  2. Obtain original "Authorizing Signature" on both printouts.  Give an original signed copy of this form to the person who reconciles your e-reports.
  3. Make checks payable to: The Ohio State University. Mail to: Amy Fovargue, 2120 Fyffe Rd., Columbus, OH 43210. POSTMARK BY JANUARY 9, send check and copy of this completed survey. 
  4. Click the NEXT button below.  You are NOT registered until you click SUBMIT on the NEXT page of the survey!
Don't forget to PRINT this page before clicking the NEXT button below.
You WILL NOT receive a confirmation email. Printing this page of the survey will serve as your receipt for the workshop.

You are NOT registered until you click SUBMIT on the NEXT page of the survey!

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