2009 MN EBD Conference Registration

2009 Minnesota Fall Conference on Programs for Students with Emotional/Behavioral Disorders

Instructional & Behavioral Practices for Students with Challenging Behaviors

Registration

Please submit one online registration per participant. You may also download a form to mail or fax.

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 (please note the extra fee for Thursday evening workshop), program, attendance certificate, continental breakfasts, refreshment breaks, Thursday reception, and lunch Thursday and Friday. 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 Oct. 7, 2009 will be honored.

Registration Options

Thursday-Friday (1 1/2 day conference)

$160 Member of MNCCBD or MSPA
Member Number:
(visit www.mnccdb.org or www.mspaonline.net for membership information)

$160 Presenter Rate

$175 Pre-Registration Rate (by October 7, 2009)

$185 Regular Registration Rate (after October 7, 2009)

$145 each Group Rate (5 or more registering together)
Please type your group member names:

N/A Exhibitor/Sponsor (2 complimentary registrations included)

N/A Staff/Planning Committee (pre-approval required)

Thursday Evening Literacy Workshop 6:30-8:30 pm

A great opportunity for reading relicensure hours.

$20 ADD to Thursday-Friday 1 1/2-day conference

$30 Literacy Workshop ONLY

Payment Options

USA Funds only please

Payable to Behavioral Institute for Children and Adolescents (FED ID #41-1703237)

Total Fee

Check check number:
mail with copy of registration form

Purchase Order P.O. number:
mail/fax with copy of registration form

Credit/Debit 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!