2016 Housing Conference for LeadingAge New York April 12-14, 2016 | Page 8

Housing Professionals Annual Conference Registration Form (page 1 of 2) April 12 – 14, 2016 Print or type. Please use one registration form per attendee. Be sure to complete both pages of this form. Name: _____________________________________________ Title: ______________________________________________________ Organization:____________________________________________________________________________________________________ Address:___________________________________________ City/State/Zip: ______________________________________________ Phone: ( )__________________________________________ Email (required):____________________________________________ LeadingAge New York member:  Yes  No Are you a first-time attendee at this conference?:  Yes  No How many years have you been a housing professional? ______  Please check here if you require specific aids or services pursuant to the Americans with Disabilities Act. Our staff will contact you to make arrangements. REGISTRATION FEES: (Please select the appropriate fee.)  LeadingAge NY Members: $149  Non-members: $169 Pre-Conference Intensive: April 12 Wed., April 13 only: (Full-day)  LeadingAge NY Members: $249  Non-members: $269 Conference: April 13 - 14  LeadingAge NY Members: $339  Non-members: $359 Thur., April 14 only  LeadingAge NY Members: $149  Non-members: $169 Wed., April 13 only: (Half-day) select session below (Applies to Intensive for Facility Managers only)  LeadingAge NY Members: $149  Non-members: $169 Payment in full must be received by the date of the conference to ensure your entry. Cancellations received by March 23 are refundable, less a 25 percent administrative fee. After that, the fee will not be refunded. Cancellations must be sent in writing to Michelle Mahoney at [email protected] or fax: [phone]. Those who register and do not comply with the cancellation policy will be billed. Substitutions are permitted. CONCURRENT SESSION CHOICES: (Please check one session per time slot.) Wed., April 13, Intensive for Facility Managers Wed., April 13: Concurrent sessions 1:15 – 2:45 p.m.  EIV  Cliques and Bullying  Rental Assistance Demonstration Update (Conference attendees may attend one or both sessions) 9 a.m. – noon  Incorporating Long Term Capital Needs in Your Daily Maintenance Plan OR 1:15 – 5 p.m.  Preparing for REAC Inspections with Hands-On Training 3:15 – 4:45 p.m.  HUD Occupancy Q & A  Neglect and Self-Neglect Special Meals Request: _#____ Vegetarian #_ ____ Gluten-free # _ ____ Kosher Summary of Charges: Please enter the applicable fees. Pre-conference fee $ ___________ Conference fee $ ___________ Total $ ___________ (continued)