Supported Life 2010 - October 6 - 8, 2010

Online Registration
Order #10336-1

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 ( )       

Email Address
6.

I will be attending (check all that apply):

Wednesday evening Inclusion Celebration
Thursday conference day
Friday conference day
7.

I am a (select one):    

Professional (or community member)
Person with a disability (paying FULL FEE) Thanks to the generous support of Supported Life 2010 Co-Sponsors (see back page for initial list), we are able to offer a subsidized registration fee (“partial scholarship”) for up to 200 people with developmental disabilities & their family members who wish to attend the conference, but are unable to pay the regular registration fee. This reduced registration fee is available for the first 200 registrations received. We do ask people with disabilities & 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. Please make use of the Reduced Fee only if it is financially necessary.
Person with a disability (paying REDUCED FEE)
Family Member (paying FULL FEE)
Family Member (paying REDUCED FEE)
Full-Time Student (you must mail or fax proof of current full-time student status to Supported Life)

SPEAKERS: Do not register online. Use the speaker registration form that was mailed to you.
8.

Are you a:

Current dues-paying member of The Arc of California?
(Entitled to $35 discount)

If yes: Chapter Name:
Chapter Name is required in order to receive your Arc discount. Contact The Arc of California at 916-552-6619 if you need help.
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).
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    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 15, 2010    ):
            

    11.

    Please indicate your one top choice for each concurrent session time. This does not guarantee a spot, but it helps us assign a room size. Note that you are not restricted to this session on actual conference days. Please keep in mind for yourself your own 2nd or 3rd choice sessions, too, in case the session you wanted is already filled that day.

    THU 10/7
    THU 10/7
    THU 10/7
    FRI 10/8
    FRI 10/8
    10:15 - 11:30
    2:00 - 3:15
    3:30 - 4:45
    9:45 - 11:00
    11:15 - 12:30
    101
    201
    301
    401
    501
    102
    202
    302
    402
    502
    103
    203
    303
    403
    503
    104
    204
    304
    404
    504
    105
    205
    305
    405
    505
    106
    206
    306
    406
    506
    107
    207
    307
    407
    507
    108
    208
    308
    408
    508

  • 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.
  • SERVICE AGENCIES! Purchase five "Professional" registrations in a single online order and receive a sixth "Professional" registration free of charge! When you fill out your sixth professional registration, the cost of the lowest-priced professional registration in your order will automatically be deducted from your order. This will be visible on the summary page after submitting the sixth professional registration.

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