Getting Back to Basics

Getting Back to Basics

Conference Registration

Conf

September 16-17 2014
Best Western Royal Plaza Hotel and Trade Center
181 Boston Post Road, West
Marlborough, MA 01752

Registrations will be accepted through August 29, 2014

Massachusetts Statewide Independent Living Council

General Information

You are cordially invited to attend the Annual MASILC Independent Living Conference at the Best Western Royal Plaza Hotel and Trade Center in Marlborough Ma.

Registration

1. Email completed registrations to or

2. Mail completed forms to:

MASILC

280 Irving St.

Framingham Ma 01702

The deadline for registration is August 29, 2014

Conference Eligibility

Conference participation is free, however space is limited. Priority will be given to MASILC members and nominees, Independent Living Center Staff and Board Members.

Overnight Accommodations

A limited number of hotel rooms are available for center staff that will be travelling long distances. These rooms are available on a first come, first served basis.

MASILC 2014 Annual Independent Living Conference

Registration Form

Please fill out the information requested as thoroughly as possible. If you need assistance please call the SILC at 508-620-7452 V/TTY.

Personal Information

First Name: ______Last Name: ______

Address______, ______, ______

Telephone: ______

Email Address: ______

Agency Information

Please check your affiliations

Massachusetts Statewide Independent Living Council Member or Nominee

Employee of an Independent Living Center

Please List the Center______

Board Member of an Independent Living Center

Please List the Center______

Employee of a State agency, collaborating agency or other agency.

Please List the Agency______

MASILC 2014 Annual Independent Living Conference

Registration Form

Food Information

First and Last Name: ______

I will attend the entire Conference and be at all meals Tues and Wednesday

I will attend Tuesday Sept 16 LunchDinner

I will attend Wednesday Sept 17 BreakfastLunch

Please indicate any dietary restriction(s):

Vegetarian Lactose Intolerant Gluten Free

Other – Specify: ______

None- regular meal

Accommodations

I would like to stay overnight at the hotel on Tuesday, September 16th.

Non smoking room Smoking room

Female Male

I need a wheelchair accessible room

Due to high demand and budgetary restrictions, it will be necessary to share rooms with other attendees. We will do our best to match people. If you would prefer to share a room with a specific attendee, please speak to them and indicate your choice below. Rooms will not be assigned until all roommates have submitted their applications, and indicated their preferred roommate(s).

Name of preferred roommate(s): ______

______

Reasonable Accommodations

First and Last Name: ______

MASILC is committed to providing participants with accommodations that will assist them to fully enjoy the conference.

Please check and include with your application if you need any of the following:

CART

ASL Interpreter

PCA (during conference hours only)

Electronic

Large print conference materials in 18 pt. font

Braille conference program books

Other Please List ______

If you need additional accommodations not listed here please call the MASILC office and speak with Sadie Simone the MASILC Coordinator at 508-620-7452.