Leadership and Collaboration: A Conference for Families and Self-Advocates” Survey

Deadline for registrations is September 18th.

If you will need accommodations please let us know by September 10th.

Thank you!!

*
1. Name:

Name:

*
2. Address:

Address:

*
3. Daytime phone number:

Daytime phone number:

4. email address:

email address:

5. Are you interested in receiving a stipend for attending? (If you check yes this registration needs to be received by Friday August 28th and you must be certain to share a phone number with us so that we can call and get some very brief, additional information, thank you!) NO LONGER AVAILABLE

Are you interested in receiving a stipend for attending? (If you check yes this registration needs to be received by Friday August 28th and you must be certain to share a phone number with us so that we can call and get some very brief, additional information, thank you!) NO LONGER AVAILABLE Yes

6. Do you require any special accommodations? Such as dietary or accessibility? If so, what are they?

Do you require any special accommodations? Such as dietary or accessibility? If so, what are they?

*
7. Morning workshop choice

Morning workshop choice Working for change: Using the power of a personal story

Leading from within

Shifting perspectives:Family and disability

Self Advocates speak up: part 1

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8. Afternoon workshop choice:

Afternoon workshop choice: Advocating for your child

Becoming comfortable with conflict

Understanding your values

Self advocates speak up: part 2

Thank you for registering for the conference and we look forward to seeing you on September 23rd at the Holiday Inn in Rutland, VT!!
Questions? Please call 802-656-1348 or 1-800-800-4005

Leadership and Collaboration: A Conference for Families and Self-Advocates”
Exit this survey

1. Default Section

*
1. Name:

*
2. Address:

*
3. Daytime phone number:

4. email address:

5. Are you interested in receiving a stipend for attending? (If you check yes this registration needs to be received by Friday August 28th and you must be certain to share a phone number with us so that we can call and get some very brief, additional information, thank you!) NO LONGER AVAILABLE

6. Do you require any special accommodations? Such as dietary or accessibility? If so, what are they?

*
7. Morning workshop choice

*
8. Afternoon workshop choice:

Leadership and Collaboration: A Conference for Families and Self-Advocates”Exit this survey

1. Default Section

*1. Name:

*2. Address:

*3. Daytime phone number:

4. email address:

5. Are you interested in receiving a stipend for attending? (If you check yes this registration needs to be received by Friday August 28th and you must be certain to share a phone number with us so that we can call and get some very brief, additional information, thank you!) NO LONGER AVAILABLE

6. Do you require any special accommodations? Such as dietary or accessibility? If so, what are they?

*7. Morning workshop choice

*8. Afternoon workshop choice:

Leadership and Collaboration: A Conference for Families and Self-Advocates”
Exit this survey

*
1. Name:

*
2. Address:

*
3. Daytime phone number:

*
7. Morning workshop choice

*
8. Afternoon workshop choice: