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| | Registration
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In order to make the conference more
accessible, the registration fee is only $35 and may be waived upon
request.
You
have several options for completing your registration:
 |
Order
by phone (you can use your credit card):
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|
Print out the order form below and send your mail order (include
check, money order or credit card information) to:
|
CAIC,
Inc.
4501
Cathedral Oaks
Santa
Barbara, CA 93110
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|
Fax / Mail
Order Form:
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|
|
Registration
Fee
|
Number
|
Total
|
|
Conference Registration |
$35.00
US
|
|
|
| q
I request a waiver of the
conference fee |
| Donate
to help others attend |
|
|
TOTAL |
|
|
Name(s)
|
|
Organization
/ Agency
|
|
Street
Address
|
|
City
/ State / Zip
|
|
Daytime
Phone
|
Fax
|
E-mail:
|
| I
am a (indicate all that apply):
q
Consumer / Self-Advocate q
Parent /
Family Member q
Advocate
q
Professional (direct support and
others) q
(Other)__________________________ |
| Special
needs and accommodations: The conference will provide
ASL interpretation and translation of major conference
documents into Braille. The conference and hotel are
wheelchair accessible. We will also try to accommodate
other individual needs and will provide translation into
selected languages. Please indicate all needs that
apply:
q
Translation to a language other than English (specify)
___________________________
q
Other physical or communication accommodations (specify):
Please
refrain from wearing scented products at the conference. |
| Child
Care: Limited on-site care will be provided if enough
families request it. Children must be registered by
December 1, 2001 by calling (J510) 383-1200 (ext. 1213).
Parents are responsible for providing food, sharing the cost
of child care, and giving any necessary medications. We
cannot provide nursing or other specialized care, and parents
must sign a waiver of liability. |
|
Credit
Card Information (we accept Visa and Master Card):
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Name on Credit Card
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Credit Card Number
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|
Expiration Date
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