Illinois Teachers of Hard of Hearing/Deaf Individuals

Illinois Teachers of Hard of Hearing/Deaf Individuals

49th Annual Conference- Lisle, Illinois

March 1stand 2nd, 2013

Conference Registration Form

PLEASE PRINT OR TYPE ITHI does not share/sell information with/to businesses or other organizations

Name:

FirstLastMaiden

Home Address:

StreetCityStateZip

Home Phone:Work Phone:Email: Email notifications included with membership

Which phone number do you wish to have included in our membership directory? Work__Home__None __

Place of Employment or College Name:

Employment Address:

Job Title: Number of years working with Deaf & Hard of Hearing, including this year:

(Excluding college classes & practicum experiences)

MEMBERSHIP TYPE: (Please Circle)RegularLifetime (Past President) StudentRetired

I AM A: (Please Circle)New Member Renewing Member

ITHI AREA: (Please Circle)1234567

Choose the area in which you currently work.89101112Out of State

If you are a college student, choose the area where your college is located. You must be attending full time to receive student status.

Please check the box(es) if you would like to volunteer with ITHI.

I would be interested in volunteering for: Board position Conference Committee

Special Projects/Committees

~Registration costs include membership to ITHI and entrance into the conference~

*Students must be full time to be eligible for discounted rates.

**Special rates per agreement with Conference Chair (names will be checked from list)

EARLY BIRD REGISTRATION: (FREE GIFT for registering early!) deadline January 26, 2013

Friday and Saturday / Friday only / Saturday only
Member $200 / Member $180 / Member $160
Past-President $150 / Past-President $130 / Past-President $110
Student* $150 / Student* $130 / Student* $110
Committee/Presenter** $50
w/ITHI annual Membership / Committee/Presenter** $50
w/ITHI annual Membership / Committee/Presenter** $50
w/ITHI annual Membership
Committee/Presenter** $0
No annual ITHI membership / Committee/Presenter** $0
No annual ITHI membership / Committee/Presenter** $0
No annual ITHI membership
Past-President/Committee** $0 / Past-President/Committee** $0 / Past-President/Committee** $0

REGULAR REGISTRATION: deadline February 14, 2013

Friday and Saturday / Friday only / Saturday only
Member $215 / Member $195 / Member $175
Past-President $165 / Past-President $145 / Past-President $120
Student* $165 / Student* $145 / Student* $120
Committee/Presenter** $50
w/ITHI annual Membership / Committee/Presenter** $50
w/ITHI annual Membership / Committee/Presenter** $50
w/ITHI annual Membership
Committee/Presenter** $0
No annual ITHI membership / Committee/Presenter** $0
No annual ITHI membership / Committee/Presenter** $0
No annual ITHI membership
Past-President/Committee** $0 / Past-President/Committee** $0 / Past-President/Committee** $0

• Friday luncheon and Saturday breakfast are included with registration.
• Vegetarian options provided. Please indicate here if you wish to have a vegetarian lunch. ______
• Lunch orders guaranteed only if ordered by Feb. 14, 2013.

Pre-Conference Workshop Registration: Deadline is February 14th, 2013.
Management of Hearing Loss- Scope & Sequence of Skills and Activities by Lynne Price, NBCT
(Encore presentation from ITHI 2012 Conference)
Thursday, February 28, 2013, 9:00-3:00 p.m.
Wyndham Lisle-Chicago
Cost: $35 (includes workshop, curriculum, and CD with activities and worksheets)
Time: 9:00-4:00
Session 1: Explanation and application of diagnostic teaching strategies
lunch on your own
Session 2: K-12 curriculum for Hearing & Technology, Listening Skills, Social-Emotional Skills, and Advocacy
Register below. / Hearing and Vision Connections – Early Intervention Outreach DTH Workshop
Thursday, February 28, 2013
Wyndham Lisle-Chicago
Cost: $0
Session I-
9:30-11:30 a.m.
Session II-
12:45-3:30 p.m.
Register through ISD Outreach- form is available
at
Supporting Success in the Fast-Paced Classroom
Presented by Dr. Karen L. Anderson, Ed. Aud.
Thursday, February 28, 2013
Wyndham Lisle-Chicago
Cost: $75
Time: 10:30-4:00
Topics will include: classroom access, communication repair and social/emotional aspects of hearing loss / Intervention Strategies for Learners with Complex Learning Needs by Dr. Christy Borders and Dr. Stacey Jones-Bock
Wednesday, February 27 – Thursday, February 28, 2013
Wyndham Lisle-Chicago
Cost: $50
This two day workshop is designed to give you evidenced-based strategies to help you work with students in your classroom or itinerant setting who have needs that go beyond that of just a “typical” Deaf student. Participants will be able to use what they learn in this hands-on style workshop!

Registration Totals

$ ______Conference registration fees

$ ______Pre-conference workshop fees (Check the pre-conference for which you are registering)

____Management of Hearing Loss – Scope and Sequence of Skills and Activities

____Supporting Success in the Fast-Paced Classroom

$ ______Apparel costs- Only available through (Feb. 14, 2013); Indicate quantity and size:

Short Sleeve: ___YS ___YM ___YL ___YXL ___S ___M ___L ___XL ___2XL ___3XL ___4XL

Long Sleeve: ___YS ___YM ___YL ___YXL ___S ___M ___L ___XL ___2XL ___3XL ___4XL

$ ______Contributions towards organization (please check one)

___Hazel Bothwell Scholarship ___Jacki Marcus Memorial Student Scholarship

___Hazel Bothwell Grant ___Area Advancement (Please indicate area you wish to receive funds ___)

$______Total Registration cost enclosed/charged

How to Register

Call(800) 877-1478 or (309) 438-2160 with Visa, MasterCard,

Discover, or American Express. Hours 8-4:30 M-F

Go onlineand pay with a credit card at:

Fax(309) 438-5364

MailSend to: Dream, Create, Activate, Achieve

Conference Services

Illinois State University

Campus Box 8610

Normal, IL 61790-8610

Methods of Payment:

__ Check enclosed payable to: Illinois State University

__ Credit Card:

__Visa__ MasterCard

__Discover __ American Express

Card #______

Expiration Date ______

Name as it appears on card ______

__ Purchase order

To use a purchase order, please list the number when registering. #______

You must mail or fax in a copy of the order with your registration.

ITHI Refund Policy

Cancellations made before February 14, 2013 will be subject to an $18.00 processing fee. No refunds will be issued if cancellation is made after February 14, 2013.

Remember to book your hotel room early!

This year’s conference location has changed, and the conference will now be taking place at the Wyndham Lisle-Chicago Hotel and Executive Meeting Center. The room rate for ITHI is $105.00 per night. The deadline to receive the group rate is February 14th, 2013. To reserve your room, call 1-866-615-4206 or 1-800-Wyndham. Please be sure to mention ITHI when reserving your room in order to secure the group rate.

Remember to Pre-order your Shirts!

Youth Sizes: Small – XL, Adult Sizes: Small – 4XL

(Be sure to mark the size and quantity of your order on the registration form)