ATIA 2018 Orlando Conference and Exhibition

ATIA 2018 Orlando Conference and Exhibition

Pre-Conference Seminars: January 30-31 (Separate fee to participate)
Exhibit Hall Open: Wednesday, January 31 – Saturday, February 3

Conference Sessions: Thursday, February 1 – Saturday, February 3

Caribe Royale All Suites Hotel & Convention Center
Orlando, Florida

ATTENDEE REGISTRATION FORM

Please print clearly or type (this form may be copied for additional registrants.)

First Name: ______

Last Name: ______

Badge Name: ______Position/Title: ______

Company Name: ______

Address: ______

City/State/Zip Code/Country: ______

Phone: ______Fax: ______

E-mail: ______

If you need to be accompanied by an assistant, please enter their name here for a complimentary assistant badge. Please note: assistant registrants are not eligible for continuing education credit.

Assistant First Name: ______Assistant Last Name: ______

Assistant Email: ______

ATIA may use personal identifiable information collected, such as to help minimize any potential hotel attrition penalties for the association. By registering for the conference you consent to such use. If you have any questions or concerns please contact ATIA at .

___ Check here if you do NOT want to receive e-mails from ATIA Exhibitors and Members with details including special offers or other conference-related materials.

If you have any special needs, accommodations, or dietary requests, please detail your requirements below:

Please note: Requests for sign interpreters must be made one month in advance of the conference. Unfortunately, requests for sign interpreters after December 29, 2017 will not be accommodated. Sighted guides are available for one hour periods onsite based on availability. Accessible conference materials will be available for download in advance of the conference.

______

ATTENDEE PROFILE

ATIA 2018

Orlando Attendee Registration Form | Page 5

1. Please indicate your attendee category (select all that apply):

(A) Accessibility Professional

(B) Advocate

(D) AT Specialist

(E) Consultant

(F) Consumer

(G) Education Administrator

(H) Federal Government

(I) Hard of Hearing/Deaf specialist

(J) K-12 educator

(K) Occupational therapist

(L) Parent

(M) Physical therapist

(N) Rehabilitation specialist

(O) RESNA ATP

(P) Speech-language pathologist

(Q) Special education director

(R) University affiliate

(S) Vision specialist

(T) Other (please specify) ______

2. Please indicate what most closely describes your role in purchasing decisions in your organization:

(A) I am the purchasing decision-maker

(B) I approve purchases

(D) I am not involved in purchasing decisions

3. How did you hear about this conference?

(A) ATIA Website (B) AT Vendor (C) Email

(D) Word-of-Mouth (E) Advance Program

(F) Conferences: AOTA, ASHA, CSUN, CTG, RESNA, Other Conference:

(please specify): ______

(G) Other (please specify): ______

4. Have you previously attended an ATIA Conference?

(A) Yes (B) No

If yes, please indicate the number of years you have attended an ATIA Conference:

(A) 1 year (B) 2-5 years

5. Please indicate your interest area(s) (select all that apply):

(A) AAC (Augmentative & Alternative Communication)

(B) Accessibility

(D) Deaf/Hard of Hearing

(E) Education/Learning

(F) Physical Access/Mobility

(G) Transition/Vocational

(H) Other (please specify)

______

6. Are you attending the ATIA Annual Conference to earn continuing education credits?

(A) Yes (B) No

If yes, what type of continuing education credit applies to you? (Circle all that apply)

(A) ACVREP (B) AOTA

(E) Other ______

7. Are you interested in attending edcampAccess International at ATIA 2018? By selecting yes, your information will be shared with the organizers of the edcampAccess International unconference.

(A) Yes (B) No

ATIA 2018

Orlando Attendee Registration Form | Page 5

Registration Categories / Fees

Please identify the fees in the proper tier associated with your registration category and include the total below.

Regular
9/30/17 – 12/1/17 / Late
12/2/17 - Onsite
Full Conference Registration includes access to the Exhibit Hall, Wednesday Opening Reception and Educational Sessions. Pre-Conference Seminars require an additional registration fee. / $550.00 / $575.00
Group Registration 5+ Attendees (discount 5% per person based on attendee fee) / $522.50 / $546.25
Group Registration 10+ Attendees (discount 10% per person based on attendee fee) / $495.00 / $517.50
Speaker Registration / $375.00 / $575.00
Parent Registration: 50 % Discount. A letter describing your child’s disability must accompany your registration. A letter can be submitted with your registration form. / $275.00 / $287.50
Student Registration: 50% Discount. Proof of your full-time student status must accompany your registration. A letter can be submitted with your registration form. / $275.00 / $287.50
Exhibit Hall (Wednesday thru Saturday) / $0.00 / $0.00
Single Day Registration
One Day Thursday (includes complimentary Saturday registration) / $300.00
One Day Friday (includes complimentary Saturday registration) / $300.00
One Day Saturday / $100.00
Pre-paid Lunch Ticket: Select Day/s required:
Tuesday / Wednesday / Thursday / Friday / $18.00 per lunch ticket
AOTA CEU Fee (Attendance forms provided online) Note: Complimentary CEUs are provided for all sessions. Specialist ACVREP and ASHA CEUs are provided for selected sessions at no cost. / $15.00

Pre-Conference Seminar Information

Pre-Conference Seminars are all-day workshops held on Tuesday, January 30 and Wednesday, January 31 presented by leading national and international AT professionals. There are separate fees to attend a Pre-Conference Seminar. Pre-Conferences are scheduled from 8:00 AM – 4:00 PM with an hour for lunch from 12:00 – 1:00 PM. Complimentary CEUs are available.

Two Day Pre-Conference Seminar (1/30-1/31/18) / $ 550.00
One Day Pre-Conference Seminar (1/31/18) / $ 325.00
Parent/Student Two Day Pre-Conference Seminar (1/30-1/31/18) / $ 385.00
Parent/Student One Day Pre-Conference Seminar (1/31/18) / $227.50

Date/Time: Tuesday, January 30 Wednesday, January 31, 8:00am – 4:00pm

Session Type: Two day

Session Code: PRE-1TW Strand: Sensory Impairment

Session Title: Alternative Technology for People Who Are Blind or Visually Impaired

Speaker: Ike Presley, National Project Manager, American Foundation for the Blind (AFB); Larry Lewis, Founder, Flying Blind, Inc.; AlysonGullette, Adjunct Professor, Salus Univeristy

Session Code: PRE-2TW Strand: Assistive Technology for Improved Function

Session Title: Communication, Learning and Access: Severe Physical and Multiple Challenges

Speaker: Linda Burkhart, Independent Consultant, Linda J. Burkhart

Session Code: PRE-3TW Strand: Assistive Technology for Improved Function

Session Title: iPAD Boot Camp – Awesome New Apps, Adaptions and Accessories

Speaker: Therese Willkomm, Director of ATinNH, University of New Hampshire

Session Code: PRE-4TW Strand: Leadership

Session Title: The Changing Role of AT Teams

Speaker: Gayl Bowser, M.S.Ed., Independent Consultant, Assistive Technology Collaborations; Denise DeCoste, Ed.D., Assistive Technology Specialist/Consultant, Accessible Technology Consulting

Session Code: PRE-5TW Strand: Leadership

Session Title: AT Bootcamp: Foundations Through Implementation

Speaker: Kelly Fonner, Education/Assistive Technology Consultant, Kelly Fonner Consulting; Mike Cole, Owner, Use Your Words, PC; Brian Wojcik, Assistant Professor, University of Nebraska at Kearney

Session Code: PRE-6TW Strand: Education/Learning

Session Title: An Eye on Visuals: Supporting Behavior, Learning, Communication and Organization

Speaker: Beth Poss, Educational Consultant, Montgomery County Public Schools

Session Code: PRE-7TW Strand: Education/Learning

Session Title: Innovative Technologies for Learners with Reading and Other Learning Differences
Speaker: KarenJanowski, MS Ed, Assistive & Educational Technology Consultant, EdTech Solutions; SharonPlante, LD Technologist, Eagle Hill Southport

Session Code: PRE-8TW Strand: Education/Learning

Session Title: Google Bootcamp 2.0
Speaker: Mike Marotta, AT Specialist, Inclusive Technology Solutions LLC

Date/Time: Wednesday, January 31, 8:00am – 4:00pm | Session Type: One day

Session Code: PRE-9W Strand: Assistive Technology for Improved Function

Session Title: Breaking Out the AT Toolkit: A Hands-on Experience

Speaker: LindseyHuntley, SLP, ATP, Speech Supervisor Center for Assistive Technology, NYCDOE Center for Assistive Technology; MaricrisFormoso-Santos, PT, ATP, AT Supervisor, NYCDOE Center for Assistive Technology, Loreto Dumitrescu, AT Evaluator, NYC DOE Center for Assistive Technology, Mylene Matro, AT Evaluator, NYC DOE Center for Assistive Technology

Session Code: PRE-10W Strand: Education/Learning

Session Title: Autism: Engagement and Creative Communication!

Speaker: Carol Allen, School Improvement Adviser (ICT and SEN), North Tyneside City Learning Centre

Session Code: PRE-11W Strand: Education/Learning

Session Title: Literacy for All: Instruction for Learners with Complex Communication Needs

Speaker: Jessica Caron, Ph.D., CCC-SLP, Assistant Professor, Department of Communication Sciences and Disorders (CSD), Penn State University; David McNaughton, Ph.D., Professor, Educational and School Psychology and Special Education, Penn State University; Christine Holyfield, Ph.D, CCC-SLP, Assistant Professor, Department of Rehabilitation, Human Resources, and Communication Disorders, University of Arkansas; Salena Babb, Doctoral Candidate in Special Education, Pennsylvania State University

Session Code: PRE-12W Strand: Assistive Technology for Improved Function

Session Title: Head, Shoulders, Knees, and Toes: Assistive Technology Access and Assessment

Speaker: Douglene Jackson, PhD, OTR/L, LMT, ATP, Occupational Therapist, University of Miami-Mailman Center for Child Development

Session Code: PRE-13W Strand: Sensory Impairment

Session Title: Practitioner’s Handbook on Technology Implementation for People with Visual Impairments

Speaker: Rachael Sessler Trinkowsky, Ph.D., CRC, CATIS, Technology Training and Vocational Coordinator, Lighthouse for the Blind of the Palm Beaches

5 WAYS TO REGISTER

ONLINE: www.atia.org/register FAX: 847-277-7414

EMAIL: TELEPHONE: 847-620-4471

MAIL: ATIA Registration, 8324 Solutions Center, Chicago, IL 60677-8003

Full payment must accompany registrations. ATIA Federal ID#: 77-0482095

Check (payable to ATIA) MC Visa AMEX Purchase Order (Original PO must accompany registration)

Total Fees Due: $ ______Discount Code (if applicable): ______

Check/Card/PO# ______Exp Date ______CVV Code ______

Name on card (please print) ______

Signature: ______

If you submit this form via fax, email, online, or mail, you are agreeing to the cancellation policy and the purchase payment policy.

Cancellation Policy: A full refund will be granted to cancellations made in writing on or before Monday, November 27, 2017. Name changes and substitutions are allowed at no fee. Regrettably, no refunds will be given on cancellations received on or after Tuesday, November 28, 2017. Phone cancellations will not be accepted. Written cancellations must be sent by email to or faxed to +1 847-277-7414.

Purchase Order Payment Policy: If your organization is required to submit a purchase order for payment, please send your purchase order document with all pages of the registration form. Registrations paid by purchase order are subject to the Cancellation Policy. Purchase order payments are due no later than 30 days after the completion of the conference, by Friday, March 2, 2018. Payments received after March 2, 2018, will incur a $75 late payment fee.

If any circumstances or event beyond the control of ATIA causes cancellation of all or any portion of the event, ATIA agrees to refund any portion of the registration fee which ATIA is reimbursed by insurance or other third party and shall not be liable for any other refund or payment arising from the cancellation or for other liability or damages arising from the event.

Please Note: On occasion, an ATIA photographer may take photos of participants at ATIA Orlando 2018, or of people participating in conference functions or activities. Please be aware that these photos are for ATIA’s use only, and may appear in ATIA conference programs, brochures, newsletters, website and other publications and materials. Your attendance constitutes your permission and consent for this photography and subsequent usage.

ATIA 2018

Orlando Attendee Registration Form | Page 5

ATIA 2018

Orlando Attendee Registration Form | Page 5