Take 5: Take Three - Event Registration

Register here for Take 5: Take Three! An Ohio Youth Services Day of Dialogue on Challenges, Solutions, and Emerging Best Practices at the Akron-Summit County Public Library and Akron Art Museum, Friday, May 9 from 10:00 a.m. - 4:00 p.m., with registration, displays, and networking beginning at 9:00 a.m. Please answer all questions below. Registration is not complete until you submit your form. If you need to keep a copy of your form for your records, please print or save before submitting.

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* 1. Registration information:

Name: *

Workplace/Affiliation:

Email Address: *

Phone Number: *

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* 2. The event fee of $15 is payable by cash or check on site and will cover your boxed lunch. Please select your lunch. All sandwiches come with pasta salad, cookies, and a drink. Salads come with rolls and butter, your choice of dressing, cookies, and drink.

Summit - Two mini bistro roll sandwiches: one with thinly sliced Certified Angus® roast beef and cheddar cheese, and another with sliced turkey breast and provolone cheese

Americana - Traditional slow roasted turkey breast, cheddar cheese, leaf lettuce and garden fresh tomato all arranged on thick sliced wheatberry bread

Garden Griller - Assorted seasonal vegetables grilled and topped with melted provolone cheese, crisp leaf lettuce and sliced tomato mounded on basil focaccia

Grandioso - Certified Angus® roast beef, hard salami, tender sliced turkey, spicy sandwich pepperoni, provolone cheese, leaf lettuce, garden fresh sliced tomato, and our zesty vegetable relish heaped on a hoagie roll

Grilled Chicken Caprese - Marinated char-grilled chicken breast, mozzarella cheese, green leaf lettuce, sliced tomato and pesto mayonnaise served on basil focaccia

Smoke House - Thin sliced smoked turkey, smoked ham, cheddar cheese, leaf lettuce and fresh tomato slices stacked on thick marble rye bread

Farmer’s Market Salad - Crisp salad greens tossed with shredded carrots, chopped celery, crisp cucumber slices, grape tomatoes, red onion and diced bell peppers

Buffalo Chicken Salad - Tossed salad greens topped with boneless breaded Buffalo chicken bites, shredded cheddar cheese, diced celery, and onion frites

Bistro Chef Salad - Mixed salad greens are chopped and covered with sliced turkey breast, cured ham, crumbled bacon, grape tomatoes, red onion, sliced hard cooked egg, cheddar and Swiss cheeses

Neo-Caesar Salad with chicken - Grilled chicken breast sliced on a bed of crisp salad greens topped with classic croutons, bacon crumbles and freshly shredded parmesan cheese

Tuscan Salad - Chopped salad greens blended with romaine lettuce, roasted red pepper strips, grape tomatoes, sliced black olives, marinated artichoke hearts, freshly shredded parmesan cheese and classic croutons

None of the above options meet my dietary requirements. I will bring my own lunch, and understand that a reduced event fee of $5 will be charged to me to cover non-lunch event costs.

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* 3. Please select your lunch drink.

Coke

Diet Coke

Sprite

Ginger Ale

Bottled Spring Water

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* 4. If you chose a salad, please select a dressing.

Bleu Cheese

Ranch

Fat Free Ranch

Golden Italian

Fat Free Italian

Caesar

Honey Mustard

Balsamic Vinaigrette

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* 5. Take 5 attendees are encouraged to share their experiences and ideas in dialogue with others, but also through a visual display area called "Windows to our World". You may bring a representation of successful activities, services or programs offered at your organization. This might include a poster or tri-fold display, slideshow on a laptop, promotional materials, etc.

In keeping with the "What If?" theme, we also welcome displays of planned, hoped-for, or just dreamed-of projects that excite you, and that you would like to make real. The "Windows to our World" display area will be open to all attendees. Feel free to bring and share anything you feel others would enjoy. Please plan to arrive at 9:00 on May 9 to set up your display.

Are you interested in contributing to "Windows to our World"?

Yes

Not sure yet; ask me later (event organizers will send a follow-up email if you select this option)

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* 6. If you answered yes, what will you be bringing (so we may create arrangements for space purposes)?

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* 7. Optional activities on Thursday evening, May 8 will include a visit to the Akron Art Museum (free admission), casual dinner with other Take 5 participants, and possibly a gallery hop or the Akron RubberDucks home game. These are opportunities to enrich and enhance your Take 5 experience, build your network, and have fun. They are on your time and at your expense.

Note: Answering Yes to the below questions does not oblige you to participate. This is to gauge interest for planning purposes, and to develop a contact list of interested attendees with whom to follow up.

	Yes	No
Are you interested in participating in Thursday activities?	Are you interested in participating in Thursday activities? Yes	Are you interested in participating in Thursday activities? No
Would you like information on area hotels?	Would you like information on area hotels? Yes	Would you like information on area hotels? No

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* 8. How did you hear about Take 5? Select all that apply.

From a colleague or friend

Take 5 website

Take 5 Facebook page

Attended last year

Attended in 2012

Email from organization (please specify in "Other" field)

Listserv/e-newsletter (please specify in "Other" field)

Other (please describe)

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* 9. (optional) Questions or comments for the meeting organizers?

Thank you for registering for Take 5! You will receive registration confirmation and full event details by email within a week of your registration. If you become unable to attend this event, please cancel your registration by emailing jdwyer@library.ohio.gov at your earliest opportunity. Please click the "Done" button below to complete your registration.