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BASA Emerging Leaders Institute 2013-2014

Welcome to all superintendents & other educators who want to sharpen their knowledge about leadership.

All sessions will be held at the Doubletree Hotel, 175 Hutchinson Avenue, Columbus, OH 43235 . Please call the Doubletree directly at 614-885-3334 to make overnight room arrangements.

Complete registration form(s) & enclose a check or purchase order & mail to : BASA, 8050 N. High St., Suite 150, Columbus, OH 43235; Fax to (614) 846-4081; or Register on-line at www.basa-ohio.org .

Full Name: _______________________________________________________________ Title: ____________________________________________________________________ Organization/School District _________________________________________________ Address __________________________________________________________________ City/State/Zip _____________________________________________________________ Phone : _________-_________-___________ Fax: _________-_________-__________ Email : ___________________________________________________________________ Conference Fees & Payment: Includes all 4 sessions or individual sessions, materials, breaks & meals. Hotel overnight rooms are NOT included.

❑ Check enclosed (payable to BASA)

❑ All 4 sessions at a reduced rate = $495.00

Purchase Order is attached

❑ October 15, 2013 - Judy Carr = $189.00

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❑ January 28 & 29, 2014 - Karla Reiss = $378.00 ( 2 day training )

Please invoice me

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Credit Card

❑ March 24, 2014 - Dr. George Goens = $189.00

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____ Visa

____ MasterCard

Card Number ________________________________________ Expiration Date ____/_______

Name on Card _____________________________________ 3-digit Security Code ________

Cancellations & Refunds Refunds or credit will be given only for cancellations made in writing (mail or fax) & received by the BASA office up to five business days prior to the event date. Cancellations 5 or less days prior to the conference are subject to a 50% cancellation fee. No refunds will be given for "no-shows." s Additional Information Participants in BASA workshops will receive a certificate of completion. Participants should discuss the outcomes of their experience with their Local Professional Development Committee (LPDC). University credit is also available.

Questions? For additional information, contact BASA at 614-846-4080 .