2013 Institute Registration

1. 2013 NPTAC Topical Institute Meetings: Minneapolis, MN

The ALLIANCE National Parent Technical Assistance Center (NPTAC) will pay for the airfare, half of the hotel cost, and per diem for meals not provided, for one person from each parent center to attend one Institute meeting. We encourage participants to share rooms so they will not incur the cost of the other half of the room. If you would like a single room, you will be responsible for half of the cost. All hotel reservations will be handled through NPTAC, including for additional parent center staff attending. Additional staff will be responsible for their own travel costs.

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1. Please provide your contact information.

Name:

Organization:

Address:

City:

State:

Zip:

Email Address:

Phone Number:

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2. Institute registration will be considered on a first come, first served basis. I would like to attend the following Institute meeting:

Technology (July 10-July 12, 2013)

Management and Leadership (September 18-20, 2013)

Transition (September 18-20, 2013)

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3. Registration Type:

I am a funded Parent Center Representative paid for by the National PTAC.

I am an additional Parent Center Staff Person and I will pay my own expenses. There is no registration fee.

I am an additional Parent Center Staff Person. There are more than 2 people attending from my center. I will pay my own expenses plus a registration fee of $125.

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4. My role at the Parent Center is:

Executive Director

PTI/CPRC Director

Trainer/Advocate

RPTAC

Board Member

Other (please specify)

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5. Please let us know when you will be arriving at and departing the hotel.

Conference Schedule:

Technology:
Wednesday, July 10, 2013: Begin at noon

Thursday, July 11, 2013: 9 am - 5 pm

Friday, July 12, 2013: End at noon

Management and Transition:
Wednesday, September 18, 2013: Reception at 5 PM

Thursday, September 19, 2013: 9 am - 5 pm

Friday, September 20, 2013: End at 3 PM

Arrival:

Date

Departure:

Date

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6. Please check one of the following:

I have a roommate preference, please room me with (enter name below):

I have no roommate preference, please assign me a roommate.

I would like a single room and be responsible for any additional costs as stated above.

I would like a double room and be responsible for any additional costs as stated above.

I will not need hotel accommodations for this event.

Roommate:

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7. Accommodation Requests:

Accessible hotel room

Vegetarian

Diabetic

Gluten-free

Dairy-free

Interpreter/Translator

Other:

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1. Please provide your contact information.

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2. Institute registration will be considered on a first come, first served basis. I would like to attend the following Institute meeting:

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3. Registration Type:

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4. My role at the Parent Center is:

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6. Please check one of the following:

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7. Accommodation Requests:

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8. Please share with us what you hope to learn from attending your selected Institute meeting: