Conference Registration

Please fill out all applicable information. NOTE: You will be redirected to this page once submitted and must must then click payment button to complete your registration.

Name*

Spouse if attending

Classification

Parent
Adult w/SB
Caregiver
Professional

Type of Caregiver/Professional if applicable

Title (for caregiver/professional)

Employer(for caregiver/professiona)

Daytime Telephone*

Email Address*

Street Address*

City*

State*

Zip Code*

Caregiver/Professional-Go to Submit Button

The following section is for sb families only.

Sponsorship:

Yes, I would like to be considered for financial aid (SB Families only).
Yes, I will be traveling over 75 miles and would like to receive a travel discount (Discount of $25 per family).

Please note: There will be NO CHILDCARE provided for this event. Parents are asked to make alternate arrangements for their children 0-4yrs of age.

Children ages 5 and up who would benefit from this information are welcome to attend.

First Child's Name

First Child's Age

Second Child's Name

Second Child's Age

Third Child's Name

Third Child's Age

Once all applicable fields are completed click on button below.

Please enter the phrase above

 

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