Supported Life 2017 - October 5 - 6, 2017

Online Registration
Order #15647-67

1.

First Name    Last Name

leave name information blank and check here if this registration is for a yet-to-be-determined attendee
      (e.g. you do not yet know his or her name, but your organization is purchasing a block of registrations)

2.

Affiliation/Agency Name

3.
Address
4.
City    State    Zip Code
5.
Daytime Telephone (      

6.
Email Address
7.

I am a (select one):    

Professional (or community member)
Person with a disability (paying FULL FEE)

Thanks to the generous support of the Supported Life 2017 co-sponsors we are able to offer a significantly reducedregistration fee for people with developmental disabilities and family members who wish to attend the conference.

We do ask people with disabilities and their family members who work in the disabilities field to request that their agency pay the Regular registration fee, to maximize our co-sponsors’ generosity.

Person with a disability (paying REDUCED FEE)
Family Member (paying FULL FEE)
Family Member (paying REDUCED FEE)
Other  

SPEAKERS: Do not register online. Use the speaker registration form that was mailed to you.

8.

I will be attending (check all that apply):

Wednesday pre-conference

Thursday conference day
Friday conference day

9.
 $
  • If you are purchasing more than one registration, this amount will be added to your total
  • Javascript must be enabled in your browser in order to see your total cost reflected here. Your total cost will be visible on the next screen (prior to checking out).
  • 10.

    Accommodations requested:

    Medically-recommended diet
    Vegetarian lunch preferred
    Sign Language interpreting services
    Conference materials in an alternative format (Braille, large print)

          Please specify request (note: all requests for accommodations must be received in
          the Supported Life Institute office by September 14, 2017
    ):
            

    11.

    Please indicate your preliminary choices of which concurrent sessions you are interested in attending (one choice per session time). You are still free to attend any session you wish at the conference.

    Thursday, October 5th
    Friday, October 6th
    10:20 - 11:30
    2:20 - 3:30
    3:40 - 4:50
    10:00 - 11:10
    2:00 - 3:10
    3:20 - 4:30
    1A
    2A
    3A
    4A
    5A
    6A
    1B
    2B
    3B
    4B
    5B
    6B
    1C
    2C
    3C
    4C
    5C
    6C
    1D
    2D
    3D
    4D
    5D
    6D
    1E
    2E
    3E
    4E
    5E
    6E
    1F
    2F
    3F
    4F
    5F
    6F

  • Click only once, then wait for the order summary page
  • You will have an opportunity to add additional registrations to your order prior to checking out.
  •