Registration Please review and verify the information below is correct and click the submit button at the bottom of the page to receive your email confirmation. If you do not receive confirmation directly in your inbox, please check your spam/junk box. If you need to change any of the information after submitting the form, please contact us. Registration closes August 30th, 2019. The early bird conference registration fee is $295 until August 12th, 2019! Check payment deadline: Close of business day on August 30th, 2019. Click submit to pay by credit card via PayPal. You do not need a PayPal account to pay with a credit card. If using assistive technology to access this form, please press the tab key to move through the form. Press the space bar to check/uncheck boxes and activate drop down menus. ONLY press the enter key if you are ready to submit this registration form. Registration TypePlease specify your registration type.*ParticipantPresenterParticipant InformationPrefixMr.Ms.Mrs.Dr.First Name*Last Name*Name as you would like it to appear on name badge (if different than above)Job Title*Company/Organization/Agency Name*Email Address* Work Phone*Cell PhoneAddress* Address 1 Address 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Lodging I will be staying at the Four Points by Sheraton LAX Hotel for the conference. Please add me to your listserv. I would like to request a vegetarian lunch. AccommodationsRequested Accommodations ASL Interpreter Real Time Captioning Alternate Formats: Braille (conference agenda only) Assistive Listening Device All requests must be made by August 23rd, 2019.Certificates and Credits InfoCertificate of Participation I would like a certificate of participation Sign in sheets for conference sessions will be made available to request AIA, ADA Coordinator, Rehabilitation Counselor, and CASp credits. To receive AIA certificates – you MUST bring your AIA number.PaymentEarly bird conference registration fee is $295 until August 12th, 2019. After August 12th, conference registration fee will be $395. Payable by credit card or check. Cancellation requests made before August 18th, 2019 will be eligible for a refund, minus a $25 processing fee. Cancellations received after August 18th will not be eligible for a refund.**The last day we will be accepting checks is August 30th, 2019.Attention: Group Payments. If you would like to make a payment as a group, please contact us at 1-800-949-4232. Please note that all the members of your group must be individually registered, and you will need to provide their names and email addresses at time of payment. Payment Type* I will be paying by check. I will be paying by credit card. Payment made by, ONLY if different from PARTICIPANT (name & email address):Once you have completed this section, click on the submit button below to go to the credit card payment page.