ADHCC Annual Conference
Registration Form
April 7-8, 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):______________________________________________
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
Concurrent session choices:
Please select the appropriate fee.
Please select one session per time slot.
Thursday, April 7
1:30 – 3 p.m.
Full conference: April 7-8
Member: $423
First-Time Attendee Member $373
Non-member: $473
Non-Pharmacological Approaches to Managing
Challenging Behaviors
Learning Lounge for Recreation Programming
(Limited to first 20 attendees registered)
Thursday, April 7 only
3:30 – 5 p.m.
Member: $239
Non-member: $279
Policies and Procedures: What You Need to Know
Recreation Programming for Individuals with
Behavioral/Mental Health Concerns
Friday, April 8 only
Friday, April 8
9:45 – 11 a.m.
Member: $199
Non-member: $249
Making Sense of the Accident and Incident
Reporting Requirements
Film Showing: “Being Mortal”
Cancellations received by March 15 are refundable, less a 25 percent administrative fee. After March 15, the fee will not be refunded.
Cancellations must be sent in writing to Michelle Mahoney at [email protected] or fax: 518.867.8386. Those who register and do
not comply with the cancellation policy, will be billed. Substitutions are permitted.
Meal tickets: Meals for one person are included in the registration fee. Additional meal tickets must be purchased for guests. Meal tickets
are non-refundable.
#
Extra meal tickets for guest(s): _____ Thursday awards luncheon @ $35 ea. = $_____
Special Meals Request:
_____ Gluten-free
_____ Frozen Kosher meal
If you or your guest require a gluten-free or Kosher meal, please indicate name:__________________________________________________
Will you be staying at the Em bassy Suites hotel?
Yes No
If no, a breakfast ticket will be provided to you.
Check here ____ if you will be attending the new program directors breakfast on Friday, April 8, from 7:30 – 8:30 a.m.
Summary of Charges: Please enter the applicable fees.
Conference fee:
$ ___________
Extra meal ticket(s):
$ ___________
Total
$ ___________
(continued)