The Voice of Behavior Analysis in Connecticut
PO Box 138 n Milford CT n 06460-0138 www.ctaba.org
9th Annual Conference * March 15, 2013
Crowne Plaza * 100 Berlin Road * Cromwell, CT
For more specific conference information check our website www.ctaba.org or email us at
CONFERENCE & MEMBERSHIP REGISTRATION
PLEASE PRINT ALL INFORMATION
Name: ______BACB Certificate #: ______
Company: ______Phone #: ______
Address: ______
City, State & Zip: ______Email: ______
FREE BUFFET LUNCH WHEN YOU PRE-REGISTER FOR THIS YEAR’S CONFERENCE COMPLIMENTS OF CTABA
**Please complete this registration form and mail with payment to: CT ABA Conference, Registration, PO BOX 138, MILFORD, CT 06460-0138. Please send conference registration and a check made payable to CTABA. If you choose to pay by credit card, you must use our PayPal located on our website www.ctaba.org. CTABA will accept credit cards for walk-ins. No refunds 15 days before the conference. Hotel Accommodations: There are a small amount of rooms available at the Crowne Plaza at a conference rate. Please contact the Crowne Plaza directly at (860) 635-2000.
Conference Registration Fees**:
Full/Affiliate: $125.00
Student Members/Family: $35.00
Late Registration (if postmarked after March 1st)/Walk in (8 am): add $15
Membership Categories:
CTABA membership is now FREE for all conference attendees. (You will automatically be considered a member unless you indicate that you do not wish to be a member.) Mark here if you do not wish to be a member. _____
Full: A full member is anyone holding a terminal degree in a discipline which is either directly related to or involving behavior analysis and whose full time professional commitments include teaching, research, and/or practice in behavior analysis. Full members are eligible to vote on ABA business matters and to participate in the nomination and election of officers. Please send vita and course records or a copy of BCBA certificate when requesting this for the first time.
Affiliate: An affiliate member or family member is anyone interested in the discipline of behavior analysis but does not meet the full membership requirements. Affiliate members enjoy all the benefits of membership except for the right to vote on matters of interest to the organization and the right to hold office. Those seeking this membership must send a letter of recommendation from a full member of CTABA.
Family: Family members are those who family members are recipients of applied behavior analysis services or are the consumer of the services. These members are not certified by the BACB.
Student: Student members are full or part time undergraduate or graduate students pursuing a degree with an emphasis in behavior analysis. Student members may only vote for student representatives. If applying for this membership, please indicate school/program: ______.
[Type text]