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Back Home Again IN - AER Each participant needs to complete a registration form.All rooms are Non-Smoking & each person MUST wear a name tag to meals this year.Pre-conference registration must be received by Aug. 24, 2022.**ACVREP/CEU s credits pending due to AER application ___$185.00 Covers the cost of a single room, Thursday evening dinner, Friday morning breakfast & conference registration___$135.00 Covers the cost of sharing a room with another individual, Thursday evening dinner, Friday morning breakfast & conference registration___$50.00 Thursday only with meal___$35.00 Friday only with meal___$25.00 Thursday only without meal___$25.00 Friday only without mealExtra Meal Tickets:___Tickets for dinner Thursday evening $25.00Total __________Tickets for breakfast Friday morning $20.00Total _______Conference registration received after August 24, 2022___$30.00 Thursday only (w/o meal)___$30.00 Friday only (w/o meal)___$50.00 both daysSpecial accommodations needed ___________________________________________I prefer information in the following format:___ print___ large print = ___ font___ Braille___ EmailName ________________________________________________________________Address _______________________________________________________________City ________________________ State ___________ Zip Code _________________Phone __________________________Email ___________________________Place of employment __________________________ Position __________________If sharing a room with another individual, name of individual ______________________Guest name(s) _________________________________________________________Add name & contact info to list of attendees - inserted into each folder. ___ YES ___ NO_________ Total amount enclosed Make checks out to IN AER Mail to: Becky Smallwood; 3409 Guion Road; Indpls, IN 46222OR For credit card payments, |
