OMDSI Registration Form

2008 Ohio-Meadville District Summer Institute Registration Form - 1 Registrant

Questions about registration should be directed to registrar@omdsi.org

Your Church/Society/Congregation Name:

Is this your first visit to Ohio-Meadville Summer Institute? yes no

Email to use for confirmation:

	Registrant #1
First Name
Last Name
Gender	M F
Street
City, State Zip
Area Code & Phone
Email
Morning Activity Choice
Morning 1st Choice
Morning 2nd Choice
Morning 3rd Choice
Everyone 18 & Under, enter grade child will be entering and the birth date
Grade entering
Birth Date
If you plan to room with someone registering on a separate form, please enter roommate's name here
Roommate:
Everyone 11 & Over: Please indicate your Volunteer Choices here:
Volunteer 1st Choice
Volunteer 2nd Choice
Volunteer 3rd Choice
Everyone of all ages, please indicate all musical groups you wish to join:
Choir
Orchestra Instrument
Small Ensembles Instr/Voice Range

Fees for SI

Room and Board	Registrant #1	FEES
@ $80	5 & Under Std	+
@ $80	5 & Under AC	+
@ $290	6-12 Std	+
@ $340	6-12 AC	+
@ $395	13 & Over Std	+
@ $445	13 & Over AC	+
@ $475	Single Room Std	+
@ $525	Single Room AC	+
@ $50	YA Con	+
	Enter housing total here:	=
Family Discounts	6 & Up on floor in adult room, 2 beds occupied	-
* Big Family Discount. Deduct an extra $100 for each registrant over after the first 4 family members are registered.		-

T-Shirts		+
	Scholarship Fund Donation: THANK YOU!!	+
	After June 1, add $75 registration fee:	+
FOR STAFF ONLY	Staff Discount Position #	-
FOR STAFF ONLY	Full Time Campership Reg Fee $25	+
	TOTAL:	=
	Deposit (at least half of full amount):	-
	Balance due on arrival:	=
Please write down the TOTAL, the DEPOSIT, and the BALANCE for your records at this time.
	No Balance! You Rock! Pick Free T-Shirt:

Health Information

First Registrant

Special dietary needs:
Known medical conditions/problems:
Known allergies to medication/anesthetics:
Health Insurance :
Physician's Name :
Physician's Phone:

Special Needs

Please enter any special needs. Do you have special parking, mobility or other needs? Need access to a refrigerator? Will you need the use of the golf cart or do you plan to rent a golf cart? Please inform us if you have children who have learning or behavioral issues teachers need to know about.

When you have completed the form, jot down the total, deposit and balance for your records, then click: .

A copy of the registration form will be sent to the first email account listed above.

To reset the form to all blank values, press this button: