2017 Quest for Success - The Ohio State University Fawcett Center
On-Line Registration - Please register for the conference by completing the following
* denotes required field
First Name*:
Last Name*:
Preferred Badge Name*:
Company Name*:
Job Title:
Street Address*:
City*:
State*:
Zip*:
Phone*:
Participants e-mail*:
Other e-mail
Fax:
TPE CONFERENCE REGISTRATION:
On Site Registration Desk Opens Sunday September 10, 2017 5:00 pm to 6:30 pm and Monday, September11, 2017 at 8:00 am
The conference sessions starts Monday, September 11, 2017.
I'm registering as:

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Applicable Fees:
Registered & PAID By Date:
Applicable
Fees
Discount
Total including Discount
Early Conference Through August 15, 2017
$695*
$50
$645*
Full Conference After August 15, 2017
$695*
No - Discount
$695*
Standard Rate - Monday Only (includes all meals)
$445
No - Discount
$445
Standard rate - Tuesday Only (includes all meals)
$415
No - Discount
$415
Standard Rate - TPE Tailgating with Technology Event Ticket Only
$60
No - Discount
$60
Standard Rate - Awards Banquet Luncheon Ticket Only
$65
No - Discount
$65
* Full conference fee includes 1 year free membership in TPE
Certificate Required? - Full Conference Only
Do you require a certificate of completion?
e Name on certificate:
TPE Tailgating with Technology Event: Monday evening, September 11, 2017
Do you plan to attend the TPE Tailgating with Technology Event Monday Sept. 11, 2017?
One TPE Tailgating with Technology Event ticket is included with each paid full conference registration. There is no cost savings if you do not attend.
Purchase a / or additional
TPE Tailgating with Technology Event Tickets:		 I wish to purchse a ticket or register one or more guests for the TPE Tailgating with Technology Event Monday, September 11, 2017
Indicate Quantity: x $60 per ticket (Early) $65 per ticket (Stadard)
Tailgating Guest Names:
TPE Awards Banquet Luncheon: Tuesday - noon, September 12, 2017
Do you plan to attend the TPE Awards Banquet Luncheon?
One Awards Banquet Luncheon ticket is included with each paid full conference registration. There is no cost savings if you do not attend.
Purchase a / or Additional Awards Banquet Luncheon Tickets:Applicable Fees - $65 - Price per additional ticket
Indicate Quantity: x $65 per ticket
Luncheon Guest Names:
Other Registration Items:
Do you have Special Needs that require our attention?

Describe Below:
Food Restrictions /needs:
Other Special Needs:
Sector Selection:
Coupon Code
Membership or SponsorshipIf your organization is a Member Organization or Sponsor, Please select your category below:
Payment:
You will receive an emailed invoice from TPE within 1-3 business days following submission of this registration form. You will have the option of payment by check or credit card online.
CANCELLATION / SUBSTITUTION POLICY: Cancellation to your registration should be made in writing. Please e-mail tiffany@partnershipohio.org or fax your cancellation to 614-515-4771.

Cancellations made on August 14, 2017 through August 31, 2017 will be subject to a $100 administration fee. Registrations that are not cancelled before August 31st and no shows will not be refunded or credited.

Substitutions may be made by calling (614) 893-0006 and providing the substitute's name.

I also acknowledge that I have read, understand, and agree to be bound by this substitution / cancellation policy.
PLEASE PRINT THIS FORM FOR YOUR RECORDS
TPE Fed ID 34-82492
Questions? Call 614-893-0006 or e-mail: tiffany@partnershipohio.org