Please provide the following contact information:

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Last Name
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Address Type	Home Work
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Your registration fee entitles you to conference sessions, program, attendance certificate, continental breakfasts, refreshment breaks, lunch each day and admittance to the Thursday reception.  REFUND POLICY: All refunds will be subject to a 20% handling charge. If you are unable to attend, submit notice in writing. NO refund requests received after Sept. 30, 2008 will be honored.

Please choose one of the following options:

Thursday/Friday Regular Conference (Thursday & Friday sessions + meals & activities)

Presenter - $235 (by 9/30) or $260 (10/1 or later)

Member of CCBD or NASP - $235 (by 9/30) or $260 (10/1 or later)

       Member Number:  

Regular - $260 (by 9/30) or $295 (10/1 or later)

Group Rate (5 or more registrants) - $200 each (must register by 9/30)

       First and Last Names of Group Members: N/A 
Thursday ONLY - $160

Friday ONLY - $160  

Exhibitor/Sponsor - 2 complimentary registrations included

Staff and Planning Committee (Pre-approval required)

* Full-time Students & Parents of students with special needs - contact us for discounted rates

Please choose one of the following options:

        Saturday Workshop Day (Saturday sessions + meals & activities)
        ADD to Regular Conference - $25 EXCEPTIONAL DEAL!

        Saturday ONLY - $160

        N/A

ADDITIONAL OPTIONS:

Donation to Tara Reilly Memorial Scholarship - amount in dollars: (tax deductible)

PAYMENT INFORMATION:

USA Funds only please. Payable to Behavioral Institute for Children and Adolescents (Fed ID #41-1703237)

Summary:

Type of Payment:

Check (mail with copy of registration form)

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

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!