Online Registration Order #21142-15
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)
Affiliation/Agency Name
I am a (select one registration type):
The generous support of Supported Life 2024 co-sponsors allows us to offer reduced registration fees to people w/disabilities & family members attending the conference not funded through a State Agency, Regional Center or Service Provider Agency.
We want to ensure all individuals and family members who are solely reliant on their personal funds can receive the subsidy to help them attend.
SPEAKERS: Do not register online. Use the speaker registration form that was mailed to you.
I will be attending (check all that apply):
Thursday conference day Friday conference day
Accommodations requested:
Medically-recommended diet Vegetarian lunch preferred Sign Language interpreting services Accommodations for conference materials Please specify request (note: all requests for accommodations must be received in the Supported Life Institute office by September 26, 2024):
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.