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									The Ohio State University is proud to host the
2012 Collegiate 4-H
North Central Region Conference:

WELCOME TO THE NUTHOUSE

                                                To register:
The 2012 Collegiate 4-H North Central Region
Conference will be hosted on the Columbus       1. Fill out the registration packet.
Campus of The Ohio State University.
                                                2. Mail form, with payment, to:
Columbus is the capital and largest city in the
state of Ohio. The university consists of over     The Ohio State University, Collegiate 4-H
1,764 acres and is the home of the Ohio State
                                                   c/o Nationwide and Ohio Farm Bureau 4-H Center
Buckeyes, over 60,000 students and more than
1,000 student organizations.                       2201 Fred Taylor Drive
                                                     Columbus, Ohio 43210
This year’s conference will include sessions
revolving around leadership, team building,     3. Late registration must be postmarked no later than
decision-making, motivational teaching and
                                                     October 26 to be accepted.
science and technology.
                                                Delegates and advisors will be notified upon the
Tours will include opportunities to visit and
                                                club’s receipt of registration forms and fees. At that
learn about various parts of our vast campus,
the popular tourist areas of Columbus and       point the registrant will receive further information
hands-on science interactions.
                                                regarding health forms, sessions, and items to bring
You will have the opportunity to make the       in order to make your stay at The Ohio State
holiday season more enjoyable for women in
                                                University as enjoyable as possible.
our community as we collect donations for
toiletry and care packages and decorate them
for the local women’s shelter.
                                                For further information or questions please contact:
Our North Central Region meeting will be held   Erin Deatherage - deatherage.5@osu.edu
on Saturday afternoon. All dues-paying
                                                Ryan Stamper – stamper.60@osu.edu
members in the region will have the
opportunity to elect members for the 2012-      Katherine Wenner – wenner.28@osu.edu
2013 officer board and to catch up on current
                                                or
important information about our region.
                                                Mitch Wilson – wilson.2105@osu.edu




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                                                                         2012 OSU Collegiate 4-H
                                                               North Central Region Conference




Personal Information:
Name:                                                                             Gender:    Male   Female
Address:
City:                                                                    State:         Zip Code:
Phone: (        )-        -                Email:
College/University:                                                      Major:
Year in School:                                                   Advisor’s Name:
Advisor’s Email:                                                  Advisor’s Phone:(     )-     -


Attending as:        Delegate          Advisor


T-Shirt Size:        XS         S      M     L       XL     XXL


Special Requests:
   Require auxiliary aids and services due to a disability
      (please specify):

Special Dietary Arrangements:
  Vegetarian         OR       Other Dietary Needs (please specify):


Travel Information:
Method of Travel:             Flying         Driving
If flying, please include flight info:
Do you need picked up from the airport?             Yes             No


                                                     Hotel Address:
                                                  The Hilton Garden Inn
                                                 3232 Olentangy River Rd.
                                                   Columbus, OH 43303
                                                     (614)-263-7200

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                                                                               2012 OSU Collegiate 4-H
                                                                       North Central Region Conference




Roommate Requests:
1.
2.
3.
   I have a disability that re quires accommodations in the hotel room or to participate in the conference
activities. (A representative of OSU Collegiate 4-H will contact you to discuss details.)


Tour Options:
(List 1st through 4th choices)
Choice
Number: Tour Name:                              Tour Description:
        COSI                                    Formerly know as the Center of Science and Industry, COSI is a
        (Additional $10 fee)                    science museum that features 300 interactive exhibits throughout
                                                themed exhibition areas. The exhibits provide experiences for all
                                                age levels and combine science facts and learning through play.

              Campus Tour                       This tour will include the legendary landmarks of The Ohio State
                                                University. You’ve seen the Ohio Stadium on TV countless times, but
                                                after attending this tour you will have the privilege of saying that
                                                you have walked on its field and also have seen other locations on
                                                campus that have been frequented by students for generations.

              Easton Town Center                Designed to look like a classic American main street, this is a
                                                beautiful space that is a must see for Columbus visitors with a love
                                                for shopping. Les Wexner, a major contributor to Ohio State,
                                                designed the area and many students frequent it for shopping or
                                                merely evening entertainment.

              Waterman’s Dairy                  Located on the Columbus Campus of Ohio State, this complex
              Farm                              includes grade A fluid milk production produced by a 100-Jersey-
                                                cow herd. The farm’s purpose is for teaching, outreach and research
                                                and visitors will have the opportunity to learn more about the
                                                milking parlor, other facilities and research that is conducted at the
                                                farm.

* Ohio State University Collegiate 4-H reserves the right to cancel any tour due to lack of interest shown or any other conflicts.



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                                                             2012 OSU Collegiate 4-H
                                                     North Central Region Conference



Session Choices:

Session 1
(List 1st through 3rd)
Session
Choice: Session Title                 Session Description:
            Decision Making           Led by Amanda Wenner, an employee of Exel and recent
                                      graduate with her Master’s in Human Resources. This session
                                      focuses on decision-making and prioritizing skills as a college
                                      student. Amanda has presented at the National 4-H Conference
                                      and countless state and university events.

          Meat Science                This session will be led by Dr. Paul Kuber, a leader in the nation
                                      for his knowledge of meat science and our Ohio 4-H Livestock
                                      Specialist. In this session delegates will have the opportunity to
                                      make sausage.

          Teaching Science and Team   Dr. Robert Horton will be leading this session, Ohio 4-H’s
          Building                    Educational Design and Science Education Specialist. The
                                      session will include fun science activities and give an
                                      opportunity to learn about team building at the same time.

Session 2
(List 1st through 3rd)
Session
Choice: Session Title                 Session Description:
            Community Involvement     This Session will be led by Dr. Joshua Kirby, the Ohio Extension
            for Collegiate Members    Specialist for 4-H Older Youth. In this session, Dr. Kirby will
                                      speak on the importance for young adults to continue to give
                                      back to their communities and his visions on how to do that.

          Decision Making             Led by Amanda Wenner, an employee of Exel and recent
          (Same as Session 1.)        graduate with her Master’s in Human Resources. This session
                                      focuses on decision-making and prioritizing skills as a college
                                      student. Amanda has presented at the National 4-H Conference
                                      and countless state and university events.

          Motivational Teaching       Craig Muhlenkamp, also the source of Saturday night’s
                                      entertainment for this conference, will be leading this session.
                                      Craig volunteers as a leader for events all over the state of Ohio
                                      and this session will focus on using motivation in your teaching.


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                                                                         2012 OSU Collegiate 4-H
                                                                 North Central Region Conference




Payment Information:
        Registration fee includes all hotel accommodations, tours, transportation, conference materials
        and meals (except dinner on Friday night).

        Early Registration must be POSTMARKED by October 10, 2012.
        Late registration must be POSTMARKED by October 26, 2012.
        Mail registration to:
        Collegiate 4-H at The Ohio State University
        c/o Nationwide and Ohio Farm Bureau 4-H Center
        2201 Fred Taylor Drive
        Columbus, Ohio 43210

Cancellation Policy:
        If requesting a refund, additional information will be required; please allow up to three
        weeks after the conference for processing.
        Requested before October 26: 100% will be refunded.
        Requested before November 2: 50% will be refunded.
        Requested before November 16: 25% will be refunded.
        Refund requests after November 16, 2012 will only be taken in extenuating circumstances and must
        be submitted in writing.
        If the tour to COSI is canceled for any reasons, delegates can request a refund of the additional fee.
        Please send refund requests or questions to deatherage.5@osu.edu.


Payment:
Delegate Registration                       $90
Advisor Registration:                       $120
Late Registration (October 26):             $120
COSI Tour Fee:                              $10
        Total Fees:
Please make checks payable to Collegiate 4-H at The Ohio State University.
Agreement:
I                 hereby acknowledge and agree to pay the above fee for registration at the 2012 OSU Collegiate 4-H North
Central Region Conference. I understand this payment must be received before my registration will be accepted. I am aware
that cancellation refund requests must be submitted by the deadlines above in order to receive the appropriate
reimbursement.
Signature:                                                                                 Date:

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