CCBD 2009 International Conference Registration

8th Biennial International Conference on Children and Youth with Behavioral Disorders

"Strategies for Promoting Academic and Behavioral Competence of Students with Emotional/Behavioral Disorders"

Please submit one registration form per attendee per event. If you prefer to mail or fax a registration form, you may download a registration page (pdf) or a copy of the complete registration brochure (pdf).

Please provide the following contact information:

First Name

Last Name

Organization

Address Type Home Work

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

(format xxx-xxx-xxxx)

Home Phone

(format xxx-xxx-xxxx)

FAX
(format xxx-xxx-xxxx)

E-mail

Confirm E-mail:

Your registration fee entitles you to conference sessions, program, attendance certificate, continental breakfasts, refreshment breaks, Thursday reception, and lunch Friday and Saturday. REFUND POLICY: All refunds will be subject to a 25% handling charge. If you are unable to attend, submit notice in writing. NO refund requests received after August 31, 2009 will be honored.

Please choose one of the following registration options:

Member of CCBD - $245 (by 8/17) or $270 (8/18 or later)

      Member Number:    Expiration:

Member of CEC (but not CCBD) - $255 (by 8/17) or $280 (8/18 or later)

      Member Number:    Expiration:

Regular Non-Member - $280 (by 8/17) or $305 (8/18 or later)

Student CCBD/CEC member* - $150 (by 8/17) or $175 (8/18 or later)

      Member Number:    Expiration:

* Required for student rate:

Advisor must confirm full-time student status with fax on university letterhead to 651-483-3879 or email to: info@behavioralinstitute.org. Student must present CEC/CCBD student membership card or copy at registration.

Presenter - $245

Exhibitor/Sponsor - 2 complimentary registrations included

Staff and Planning Committee (Pre-approval required)

PAYMENT INFORMATION:

USA Funds only please. Payable to CCBD-PDC (Fed ID #54-1777499)

Summary:

Conference Registration Rate

Type of Payment:

Check (mail with copy of registration form)

Check #

Purchase Order (mail or fax with copy of registration form)

Purchase Order #

Credit/Debit Card - After you submit your registration using the SUBMIT button below, you will receive a confirmation page with an opportunity to enter your credit/debit card information and activate your registration.

SPECIAL NEEDS: Please indicate if you have any special needs or requests.

THANK YOU!