ATIA 2013 Orlando Conference and Exhibition Pre-Conference Seminars: January 29-30, 2013 Conference: January 30 – February 2, 2013 Caribe Royale Orlando All-Suite Hotel & Convention Center, Orlando, FL ATIA 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 an assistant badge. (There is no fee for assistant badge) Assistant First Name:___________________ Assistant Last Name:_______________ Assistant Email: ______ Please circle the fees associated with your registration category and include the total below. Until 9/29/2012 11/17/2012 After 1/11/2013 9/28/2012 - 11/16/2012 - 1/11/2013 Onsite Attendee Registration $435 ___ $495 ___ $520 ___ $545 ___ Group Registration 5+ ($30 discount per person) $405 ___ $465 ___ $490 ___ $515 ___ Group Registration 8+ ($50 discount per person) $385 ___ $445 ___ $470 ___ $495 ___ Conference Partner Discount Registration (5%) $413.25 ___ $470.25 ___ $494 ___ $517.75 ___ Enter Code: _______ AOTA Member Discount (10%) $391.50 ___ $445.50 ___ $468 ___ $490.50 ___ Enter Code: _______ Past Attendee Discount Registration (5%) $413.25 ___ N/A N/A N/A Code: PAD3 Exhibitor VIP Customer Discount (5%) $413.25 ___ $470.25 ___ $494 ___ $517.75 ___ Enter Code:_______ Enter Exhibitor Company Name:_________________ Speaker Registration $350 ___ $350 ___ $400 ___ $400 ___ Parent/Student Registration * (50% discount) $217.50 ___ $247.50 ___ $260 ___ $272.50 ___ Exhibit Hall (Wednesday evening & Thursday) $99.00 $99.00 $99.00 $99.00 Exhibit Hall (Friday & Saturday morningn) $0 ___ $0 ___ $0 ___ $0 ___ Single Day Attendee Registration * One Day Thursday $250 ___ $250 ___ $275 ___ $275 ___ One Day Friday $250 ___ $250 ___ $275 ___ $275 ___ One Day Saturday $100 ___ $100 ___ $125 ___ $125 ___ Parent/Student Registration * (50% discount) One Day Thursday $125 ___ $125 ___ $137.50 ___ $137.50 ___ One Day Friday $125 ___ $125 ___ $137.50 ___ $137.50 ___ One Day Saturday $50 ___ $50 ___ $62.50 ___ $62.50 ___ Pre-paid Lunch Ticket $13 Tuesday ___ $13 Wednesday ___ $13 Thursday ___ $13 Friday ___ AOTA CEU Fee (Attendance forms provided online and onsite) $15 ___ Attendee Pre-Conference Seminar (one day) $275___ $275___ $300___ $300___ Select 1 Pre-Con code from listing below:_____________ Attendee Pre-Conference Seminar (two day) $490___ $490___ $525___ $525___ Select up to 2 Pre-Con codes from listing below:_____________ _____________ Parent/Student Pre-Conference Seminar(one day)* $137.50 ___ $137.50 ___ $150___ $150___ (50% discount) Select 1 Pre-Con code from listing below:_____________ Parent/Student Pre-Conference Seminar (two day)*$245___ $245___ $262.50___ $262.50___ (50% discount) Select up to 2 Pre-Con codes from listing below:____________ ____________ PRE-18W AT Research Symposium 5% discount $261.25___ $261.25___ $285___ $285___ for ATIA, RESNA and RERC members Enter Code: ___________ *Must provide supporting documentation (may register online and upload documentation): Parent to provide letter; Student to provide proof of full time status. TOTAL $ ____________ ADDDITIONAL INFORMATION PRE-CONFERENCE SEMINARS Tuesday & Wednesday, January 29 & 30, 2013, 8:00 a.m. - 4:00 p.m. This Pre-conference Seminar is a 2 day course and cannot be selected with any other pre converence seminar. Seminar fee includes course materials. Additional onsite materials fee may apply - Check wwww.atia.org for details. __ PRE-01TW: Multi-Modal Communication and Learning Strategies for Children with Significant Challenges __ PRE-02TW: IPad Boot Camp - Awesome New Apps, Adaptations, Resources and Research __ PRE-03TW: Mission Possible: Proliferating a Culture of Universal Design For Learning __ PRE-04TW: Assistive Technology Bootcamp Tuesday, January 29, 2013, 8:00 a.m. - 4:00 p.m. Only one Pre-Conference Seminar may be selected for the day. Seminar fee includes course materials. Additional onsite materials fee may apply - Check wwww.atia.org for details. __ PRE-05T: Unlocking All the Doors: Overcoming Hurdles to Accessible Informationin Higher Education __ PRE-06T: Electronic Literacy: Engaging Reading Comprehension with iTools & Assistive Technology __ PRE-07T: Continuity in AT Use: Transitions to Support Living and Employment __ PRE-08T: Determining the Right AT for People with Visual Impairments __ PRE-09T: Creating, Finding, and Using Accessible Text and E-Reading on iDevices With FREE Software PRE-CONFERENCE SEMINARS Wednesday, January 30, 2013, 8:00 a.m. - 4:00 p.m. Only one Pre-Conference Seminar may be selected for the day. Seminar fee includes course materials. Additional onsite materials fee may apply - Check wwww.atia.org for details. If you are registering for a Pre-Conference Seminar, please select from the list below. __ PRE-10W: New Technology & Accessibility in Higher Education - Promises and Challenges __ PRE-11W: Creating Communication Opportunities: Let's Give Them Something to Talk About! __ PRE-12W: Beyond the Wow: Managing, Maintaining, & Making the Most of your Apps __ PRE-13W: Projection & Reflection - Integrating IWB's, iPads and Web 2.0 Programs __ PRE-14W: Electronic Literacy: Demonstrating Knowledge through Writing with iTools & Assistive Technology __ PRE-15W: Building Better Books to Bridge Print Barriers Page by Page __ PRE-16W: After the Assessment: Strategies for AT Implementation __ PRE-17W: But do they WANT it? Better matching consumers with AT __ PRE-18W: AT Research Symposium Sponsored by ATIA and RESNA __ PRE-19W: Selecting a Video/Electronic Magnifier and Instructional Strategies for Its Use __ PRE-20W: G3ict – AT Leadership Forum __ PRE-21W: Assistive Technology Obligations and Options for Transitioning Students ___ 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. 5 WAYS TO REGISTER ONLINE: www.atia.org/register FAx: 847-277-7414 MAIL: ATIA Registration, 8324 Solutions Center, Chicago, IL 60677-8003 EMAIL: registration@atia.org TELEPHONE: 847-620-4471 PAYMENT INFORMATION: Full payment must accompany registrations. ATIA Federal ID#: 77-0482095 Check (payable to ATIA) MC Visa AMEX PO (Original purchase order must accompany registration) Total Fees Due: $ __________________________________________________________________________ Check/Card/PO# _________________________________________ Exp Date ________________________ Name on card (please print) ________________________________________________________________ Signature: ________________________________________________________________________________ Cancellation Policy: A full refund will be granted to cancellations made in writing on or before November 30, 2012. To cover administrative costs, a service fee of $100 will be charged for all cancellations received from Saturday, December 1, 2012 through Friday, December 28, 2012. Name changes and substitutions are allowed at no fee. Regrettably,no refunds will be given on cancellations received on or after Saturday, December 29, 2012. After December 29, 2012,you may transfer your registration to Orlando 2014. Phone cancellations will not be accepted. Written cancellations must be sent by email to registration@atia.org,faxed to +1 847-277-7414 or mailed to ATIA. 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 2013, 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. ATTENDEE PROFILE 1. Please indicate your attendee category (select all that apply): (A) Accessibility Professional (B) Advocate (C) AT Dealer (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) Speech-language pathologist (P) Special education director (Q) University affiliate (R) Vision specialist (S) 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 (C) I recommend/influence purchasing decisions (D) I am not involved in purchasing decisions 3. How did you hear about this conference? (A) ATIA Web site (B) AT Vendor (please specify) ________________________________ (For Exhibitor VIP Customer Discount) (C) Conferences CSUN, CTG, Other (please specify) ________________ (D) Direct mail brochure (E) E-Mail (F) Word-of-mouth (G) Other (please specify) ____________________________________ 4. Please select conference materials in any of these alternate formats (Limited availabilty - must be requested by December 31, 2012): (A) USB with accessible materials including electronic Braille files (B) Braille Schedule of Events (C) Braille General Conference Information (D) Braille Session Grid (E) Tactile Exhibit Hall Floor Map/Exhibitor List (F) Large Print Schedule of Events (G) Large Print General Conference Information (H) Large Print Session Grid (I) Sign interpreter (J) Other (please specify) ______________________________________ 5. Have you previously attended an ATIA Conference? Yes No 6. Please indicate your interest area(s) (select all that apply): (A) AAC (Augmentative & Alternative Communication) (B) Accessibility (C) Blind/Low Vision (D) Deaf/Hard of Hearing (E) Education/Learning (F) Physical Access/Mobility (G) Transition/Vocational (H) Other (please specify) ___________________________________ 7. What type of smartphone or mobile device will you have onsite: (A) iPhone (B) Android phone (C) Blackberry (D) Windows Mobile (E) iPad / Tablet (F) Other (please specify)___________________________________