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Event Information
DATE: Friday, August 16, 2019

TIME: 12:00 pm - 2:00pm (Registration begins at 11:30 pm)

Location:   Madison-Champaign ESC
2200 S US Highway 68
Urbana, OH, 43078

Credit: Contact Hours Provided by the ESC

Registration Fee: 

Payment Options:

Payment methods include cash, check, purchase order or credit card
(there is a 3% surcharge on all credit card payments)..

Payment can be mailed, emailed, or faxed to:

Mail to :  Madison-Champaign ESC
               Attn: Ashley Carey
               2200 S. U.S. Highway 68
               Urbana, OH 43078

Email: Ashley Carey at

Fax: 937-652-2221

For Credit Card Payments: Contact Ashley Carey at or call 937-484-1557

Questions:  Contact James Cutlip at
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Registrant's Title / Position *
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Registrant's Phone Number *
Please provide a phone number to be used in the event of a late cancellation.
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Registrant's District / Organization *
Please list the organization responsible for paying the registration fee.
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