Ohio LTC – Summer 2018

Your Name:
Age:
Sex: MaleFemale
Grade (your grade level fall, 2019):
Email Address:
Home Address:
City:
Zip:
Home Phone:
School:

I would like to REGISTER for the following CONFERENCE OPTION:

ROOMMATE REQUEST

Use only if needed.

Roommate 1 Name:
Roommate 2 Name:
Roommate 3 Name:

OhioLTC REFUND POLICY: Full refund of FEES paid until May 1 - after May 1 FEES paid are non-refundable.