Full Name:  
Address:  
 
Email Address:
Phone Number:
Fax Number:
  Is this contact information?
Special Needs and/or Dietary Restrictions:  


Your $80.00 registration fee includes meals and materials only. If you need to make hotel reservations, please contact the Columbus Airport Marriott Hotel directly at 614.475.7551 or toll free at 800.491.5717. Mention the Ohio SIBS conference to receive the special room rate. We regret that Ohio SIBS, Nisonger, our affiliates and volunteers cannot assist you with hotel reservations.

Financial assistance for the conference may be available by contacting your County Board of MR/DD.
 
We would appreciate learning a little more about you so that we may provide programs and services that may be of special interest and appeal to you and the rest of our attendees. Please answer the following questions to help us serve you better:
How did you hear about Ohio SIBS? (check all that apply)





(please specify) 
What year(s) did you attend the Ohio SIBS conference?
Does your sibling live in Ohio? If not in Ohio, what State?  
Do you have primary care responsibilities for your sibling?
Are you employed in the MR/DD field?
Do you know any other adult sibling(s) who could not attend the conference, but would like to receive information about the organization and future events?
Please list their name and contact information:
Name
 
Address
 
E-mail
 
Company
 
Phone
 
 
Thank you for registering! We look forward to seeing you at the conference.
 


Questions or comments regarding this information should be directed to:
Tom Fish Director of Family and Employment Services,
The Ohio State University Nisonger Center Columbus, Ohio
(614)-292-7550 or fish.1@osu.edu



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