National Family Conference - Registration
August 12-14, 2005

Name:
Address:
City: State: Zip:
Daytime Phone:
Email:

Conference Fees
(Early Bird Reg. Must Be Postmarked By July 18, 2005)

		Early Bird Registration	After July 18th
Full Conference (Fri. - Sun.) Includes 2 meals	Family*	$ 100.00	$ 150.00
	Adults (19+)	$ 40.00	$ 50.00
	Child (5-18)	$ 15.00	$ 25.00
	Age 4 & under	Free	Free

One Day Only Includes 1 meal	Family*	$ 75.00	$ 85.00
	Adults (19+)	$ 25.00	$ 35.00
	Child (5-18)	$ 10.00	$ 20.00
	Age 4 & under	Free	Free

*Family registration is limited to two adults and children of the same family.

Number Attending:

Full Conference	# Family	@ $ each	= $
	# Adults	@ $ each	= $
	# Children	@ $ each	= $
	# Children 4 & under (free)

One Day Only	(Specify Friday, Saturday, or Sunday)
	# Family	@ $ each	= $
	# Adults	@ $ each	= $
	# Children	@ $ each	= $
	# Children 4 & under (free)

Anticipated Arrival Date & Time:			TOTAL $

Only cash or checks accepted at on-site registration. No refunds will be made.

Child Care - Important!

If you will require child care during the conference, it is VERY important that you register ahead of time so that we have a sufficient amount of space and child care workers available.

Payment Method

Checks: payable to the National Family Conference

Credit Card: Visa MasterCard
Card Number:
Expiration Date:
Print name as it appears on card:

Signature: ______________________________________________

Registration Detail

Category	Name(s)	Age
Adults		N/A
		N/A
		N/A
		N/A
Children Age 12-18 (Needing Childcare)



Children Age 12-18 (Participating in Conference Activities; not needing Childcare)



Children Age 0-11 (Needing Childcare)

Arrival Date: Departure Date:

Meals Attending

Friday Reception # attending:
Saturday Family Activities # attending:
Saturday Luncheon # attending:
Sunday Brunch # adults & children over age 11 attending:
Sunday Brunch # children age 4-10 (who are ½ price) attending:
Sunday Brunch # children age 3 and under (who are free) attending:

Please Check the Saturday/Sunday Workshops You Plan to Attend so We Can Adequately Plan for Our Meeting Room Needs.

First Breakout Session - Saturday Morning 10:15-11:15

Accessible Testing
Daily Living Skills
Early Literacy/Perkins Panda
Braille for Parents
Teen Panel
Preparing Youth for a Guide Dog Lifestyle

Second Breakout Session - Saturday Morning 11:30-12:30

O & M for Preschoolers
O & M for Adolescents
Communication: Focus on Children with Multiple Disabilities
Overview of Technology
The Expanded Core Curriculum

Third Breakout Session - Saturday Afternoon 2:45-3:45

On The Way To Independence: Strategies for Paving the Way
Grandparents Panel
IDEIA: What Parents Need to Know
What Lies Ahead: On the Way to Literacy
Partnerships & Advocacy
Educating Children with Multiple Disabilities

Fourth Breakout Session - Sunday Morning 9:15-10:15

Dad's Panel
Social Skills
The Three C's to Independence
APH Products
Believing You (Your Child) Can Do: Parent-Child Beliefs about Physical Activity-Going in Positive Directions
Improving Transition Service Delivery by Partnering with Parents

Program Media and Special Needs

The conference will endeavor to accommodate the services below if requested prior to the pre-registration deadline of July 18, 2005. Please check any of the following that you may require during the conference:

braille program
platform interpreter
restricted field interpreter
tactile interpreter
assistive listening device
Spanish interpreter
I have a T-switch on my hearing aid

Other special needs:

For the Eye Condition Roundtable, please select the group you would like to attend:

Albinism
Aniridia
Anophthalmia/Microphthalmia
Cataracts & Glaucoma
CHARGE
Colaboma
Cortical Visual Impairment
Corneal diseases
Deaf/Blind
Medically Fragile
Multiple Handicaps
Optic Nerve Atrophy/Hypoplasia
Retinal conditions
Retinoblastoma
Retinopathy of Prematurity
Toxoplasmosis
Other:

Office Use Only:	Date Received: ________   Check # ______      C.C. ________  
			Amount: $ ___________    Receipt Card Issued: ___________

If you wish to stay at the Galt House during the conference, you must make separate reservations with the hotel before July 18, 2005. Following is HOTEL registration information:

LODGING:
Galt House Hotel
Fourth Street at the River
Louisville, KY 40202
www.galthouse.com

Rates: $85 Suites ~ $77 Regular Room
Rooms must be guaranteed with a credit card
Special accommodations must be arranged with hotel.

For room reservations, call 1-800-843-4258 by July 18, 2005 and mention the APH National Family Conference and date. Do not call this number for Conference information.

Mail this completed form, postmarked no later than July 18, 2005

Use the "Print Form" button or your browser's "Print" function to print this form. Mail the printed form to the address below.

Burt Boyer/National Family Conference
American Printing House for the Blind
1839 Frankfort Avenue
Louisville, KY 40206-0085

Email: bboyer@aph.org
Toll free 1-800-223-1839, x. 264
Phone (502) 899-2264
FAX (502) 899-2269

National Family Conference - Registration August 12-14, 2005

Conference Fees(Early Bird Reg. Must Be Postmarked By July 18, 2005)