Conference Registration Form

 

Conference Website
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International Conference on Self-Determination

Online Registration Form
May 27-29, 2008
Conference Program at a Glance
Marriott Renaissance Center, Detroit, Michigan, USA

REGISTRATION FEE (per person)
The full conference registration fee provides you with a program packet, workshops, two breakfasts, two lunches, opening reception and all breaks
  Early Bird After 5/1/08 Discounts
Full Conference $275 $350 10% for 5 or more

Registration Questions?  Please call (517) 374-6848

Registrant Name
Registrant Title
Bd/Agency
Bd/Agency Address
City, State & Zip
Country  
Phone
Fax
Email
In Case of Emergency During Conference Please Contact 
Daytime Phone
Evening Phone
Cost $275 - REGISTRATION FEE (per person)
The full conference registration fee provides you with a program packet, workshops, two breakfasts, two lunches, opening reception and all breaks
Personal Assistant  I am a Personal Assistant who will be assisting (separate registration required)   (name required) during the conference.  A Personal Assistant is someone who assists people with disabilities with tasks essential for daily living. These tasks include bathing, dressing, getting around, toileting, eating, etc.  There is a special conference rate for Personal Assistants of $125.
Meal Choices Please check all meals you plan to attend (Meals are included in the cost of the conference registration):
Tuesday Reception
Wednesday Breakfast
Wednesday Lunch
Thursday Breakfast
Thursday Lunch
Disability Accommodations Disability accommodations (including dietary and alternative format) will be provided when written requests are received 10 business days prior to the conference.  Clearly state your specific needs below.  On-site requests will be attempted, but cannot be guaranteed.
Payment Type  Payment DOES need to accompany registration form.  Please note that confirmation letters will NOT be sent.  If you require confirmation, please contact Annette Pepper at apepper@macmhb.org
Mail check payable to:  MACMHB, 426 S. Walnut,  Lansing, MI  48933
PO #
Credit Card
Credit Card Type Visa   Master Card   American Express   Discover
Credit Card Number
Expiration
Contact Person (in case of problem with payment)
Phone Number
Cancellation Policy Substitutions are permitted at any time. No shows will be billed at the full training rate. Cancellations must be received in writing at least 10 business days prior to the training.  All cancellations will be assessed a $25 administrative fee. If cancellation is received less than 10 business days prior to the training, no refund can be given.