Online Registration

Registrant Information

Age*	Youth	Adult
Gender*	Male	Female
Date of Birth (Youth Only)
If youth, list conference adult sponsor's name

Name*
Title (if applicable)
Agency
Address*
City*
State*
Zip*
Phone*
Fax
Email*

Check box if billing Information is the same as above.
If billing information is different from above fill in the boxes below.

Name*
Address*
City*
State*
Zip*
Phone*
Fax
Email*

Lodging and Meals - per person

Three Nights (includes 8 meals)	Single	$	482
	Double	$	298
	Triple	$	250
	Quad	$	222

Conference Registration Fee		$	225

Total (calculate)		$

Please list the name of the others you wish to room with:

1.
2.
3.

Special Accommodations: Services can be provided for those with disabilities.

PLEASE NOTE: The National 4-H Conference Center requires a notarized letter of permission from the legal guardian of each youth in order for the youth to stay in the same room with an adult. This notarized letter must be presented at the desk at the time of check-in.

Payment Method

Credit Card
Purchase Order (FEIN #73-6017987)

Cancellations

$25 of your registration fee is nonrefundable. The remainder will be refunded if NRC receives written notification at least two weeks prior to the event.

For more information about registration contact Heather Engle, (918) 660-3700, or by e-mail at hengle@ou.edu.

For more information about the conference program, contact Joe E. Johnson, Conference Coordinator, 918/660-3700, or by e-mail at jejohnson@ou.edu.