AMTA Ohio

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AMTA - Ohio Chapter
2010 Annual Convention Registration Form

Attendee Contact Info

Name:*
Member Number (if AMTA member only):
School (if current student only):
Address 1:*
Address 2:
City:*
State:*
Zip:*
Phone:*
Email:*

Method of Payment

Credit Card (Paypal)

Payment by check must be mailed to Chapter Office. All payments in U.S. funds, draw on U.S. bank. $25 fee charged for returned checks.

Please indicate the number of CEUs you plan to attend

	Member	Non-member	Student
2 CEUs (no meals)	$50	$65	$40
4 CEUs (no meals)	$100	$125	$75
6 CEUs (includes no meals)	$150	$185	$110
8 CEUs (includes 2 meals)	$190	$240	$140
10 CEUs (includes 3 meals)	$245	$315	$185
12 CEUs (includes 3 meals)	$280	$355	$210
14 CEUs (includes 3 meals)	$315	$395	$235
16 CEUs (includes 3 meals)	$350	$435	$260

Please indicate the Meal Functions you plan to attend

Your registration fees include continental breakfasts and breaks. Lunch and Dinner functions are required to presesnt your meal ticket at the door. The number of meal functions included in your registration is noted above. If you wish to attend an additional meal function that is not included in the price of your registration, or you wish to bring a guest, additional meals can be purchased. Additional lunches can be purchased for $25 per person and dinners can be purchased for $35 per person. Please indicate the meals below that you select based on your CEU selection above. Please also indicate quantity for each additional meal ticket you require and add appropriate cost to your total registration fee.
Qty CEU Meal(s)	Qty Add'l Meal(s)
		Saturday - Chapter Networking Luncheon
		Saturday - Dinner Banquet/Dance
		Sunday - Annual Meeting Luncheon
Please indicate the number of vegetarian meals you require

Saturday: please indicate the Courses you plan to attend

Sa/Sun: Orthopedic Massage for Complicated Shoulder, Elbow, Wrist & Hand Conditions, Including Pelvic Stabilization (16 CEUs) - 2 FULL DAYS Sat. & Sun.
Sa/Sun: Sports Massage: Pre & Post Event (12 CEUs) - FULL DAY Sat., HALF DAY Sun.
Sa: Breema Bodywork: A Wellness Retreat (8 CEUs) - FULL DAY
Sa: Ethics In-Depth Discussion (4 CEUs) - 8:00am - 12:00pm
Sa: MERT Responder Training (4 CEUs) - 8:00am - 12:00pm
Sa: How To Solve Your Marketing Puzzle (4 CEUs) - 1:30-5:30pm
Sa: MERT Team Lead Training (4 CEUs) - 1:30-5:3-pm

Sunday: please indicate the Courses you plan to attend

CLASS FULL Sun: The Art and Application of Kinesiology (8 CEUs) - FULL DAY
Sun: A Massage Therapy Approach to Migraine Headaches (8 CEUs) - FULL DAY
Sun: Ethics In-Depth Discussion (repeat) (4 CEUs) - 8:00am-12:00pm
Sun: Basic Laying on of Stones (2 CEUs) - 1:30-3:30pm
Sun: As Above, So Below, Advanced Class (2 CEUs) - 3:30-5:30pm

Cancellation Policy Registrations cancelled prior to Saturday, April 16, 2010 will receive a refund minus a $25 processing fee. After Saturday, April 16, 2010, no refunds will be offered.

Guest Policy You are welcome to bring a guest. Guests are not allowed to attend classes and CEU credits will not be given to guests. If you plan to bring a guest to a meal function, please contact the AMTA – Ohio Chapter Office will make arrangements to register and pay for your guest.

Supply Lists A supply list (if applicable) will be sent with the confirmation of registration and payment.

Services for Physically Challenged Individuals The AMTA – Ohio Chapter takes reasonable steps to ensure no individual who is physically challenged is discriminated against because of the absence of auxiliary aids and services. If special arrangements or diet are required for an individual to participate in this program, please contact us in advance at (800) 281-6548 or Info@AMTAOhio.org.

Confirmation Notice Confirmation of your registration and payment will be emaield to you for online registrations. The Ohio Chapter will be glad to mail a paper copy if you require one. Please check here for your confirmation to be mailed.