2010 MIEBD Summer Institute Registration Form

MIEBD Summer Institute

"Practical Tools for Meeting the Needs of Students with Challenging Behaviors"

Please submit one registration form per attendee per event.

REGISTRATION FORM

Contact Information

First Name

Last Name

Organization

Address Type Home Work

Street Address

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:

Course Selection & Fees

Please select the days you wish to attend. Hold down the CTRL key to highlight multiple selections. Please note that participants seeking University Credit must register to attend all 5 days.

Please select your registration fee due:

Registration fees are based on the total number of days selected. Registration includes course instruction, handouts, certificate of attendance and beverage breaks. Additional costs NOT covered MAY include: university tuition, books, travel, lodging, and meals. REFUND POLICY: All refunds will be subject to a 25% handling charge. If you are unable to attend, submit notice in writing. Refund requests must be received by July 19, 2010. Participant substitution is permitted.

PAYMENT INFORMATION:

USA Funds only please. Payable to BICA (Fed ID #41-1703237)

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!

August 2-6, 2010

Roseville, Minnesota

Arnold Goldstein Memorial Library

Key Dates

August

2 Day 1 - Using Skill-Based Assessment to Make Decisions for Students with Challenging Behaviors

3 Day 2 - Teaching with Web Technology

4 Day 3 - AM: Substance Abuse Prevention

PM: Motivating the Reluctant (and Challenged) Reader

5 Day 4 - FBA/RTI: Tools to Teach Pro-social Skills

6 Day 5 - More Tools to Ensure Your Efforts Pay Off for Students

Credits & CEUs

National Association of School Psychologists

Behavioral Institute for Children and Adolescents is approved by NASP to provide continuing professional development credits for school psychologists.

APS provider #1038

State of Minnesota Board of Social Work

Behavioral Institute for Children and Adolescents is an approved Continuing Education Provider.

CE provider #CEP-218

BICA secures additional board approvals for specific professional development offerings. Please contact us with specific questions regarding professional development credits.

MIEBD Summer Institute

"Practical Tools for Meeting the Needs of Students with Challenging Behaviors"

Course Selection & Fees

PAYMENT INFORMATION:

August 2-6, 2010

Roseville, Minnesota

Key Dates

Sponsors

Credits & CEUs