International Council for Children

with Behavioral Disorders

 

Professional Development

2008 International Forum

The Literacy and Social Development Connection:

Using Effective Instruction to Improve Outcomes for Children and Adolescents with Challenging Behavior

 

February 8-9, 2008

Norfolk, VA

Forum Information 08 Handouts

 

 

2008 International Forum Registration

 

Please submit one registration form per participant. If you prefer to mail or fax a registration form, you can download a registration form (pdf).

Please provide the following contact information:

First Name
Last Name
Middle Initial
Home Address (street)
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:

REGISTRATION OPTIONS

The Forum registration fee includes: lunch, breaks and training materials.

 

EARLY (Register by December 15, 2007 January 4, 2008)

CEC/CCBD Member Rate (current membership required) - $350

        member number

Early Registration Rate - $375

REGULAR (Register December 16, 2007 January 5, 2008 - January 19)

CEC/CCBD Member Rate (current membership required) - $375

        member number

Regular Registration Rate - $400

STAFF (Register before January 19)

Staff/Trainer (pre-approval required)

TEAM DISCOUNT

If you are a member of a team (3 or more people from the same district/agency/institution), you may take 10% off your registration fee. All team members must submit a separate registration form along with one form of payment. Please select the appropriate registration option above.

Are you registering as a member of a team?

Enter team names (if applicable):

 

CEU Credits (1.2 CCBD CEUs available)

CCBD CEU credits are available for $4 per .1 CEU. You may choose to purchase up to 1.2 CEU credits.

# credits desired: 

 

FEES SUMMARY:

Registration  $ (don't forget to subtract 10% if you are part of a team)

CEU credits $

TOTAL $

REFUND POLICY: Since this is a limited participation Forum, no requests for refunds will be honored after January 19, 2008. Any refunds by that date will be subject to a 25% handling charge.

PAYMENT OPTIONS:

USA Funds only please. Payable to CCBD Forum (Fed ID #45-1777499)

Check/Money Order (mail with copy of registration form)

Check #

Amount $


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

Purchase Order #

Amount $


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.

Amount $

SPECIAL NEEDS: Please indicate if you have any special needs or requests, including dietary restrictions.

 

THANK YOU!

M. Knoll
Copyright © 2007 [Behavioral Institute for Children and Adolescents]. All rights reserved.
Revised: 06/10/08

 

July 14, 2008

© 2008 Behavioral Institute for Children and Adolescents