R e g i s t r a t i o n F o r m On-Site G r a n d R a p i ......Title: Mail in Registration Form...

On-Site Registration Form ATRA Annual Conference 2018 Grand Rapids, MI September 13 – 16 2018 $360 $180 $510 $275 Yes Badge: Full Name Organization CTRS? No Other Credentials Badge City & State Mailing Address Mail - In & On - Site Registration Form City, State, Zip Phone E-Mail Step 1 - Select Your Registration Package | Full Conference or Daily Rate Full Conference Package Early Bird (Until 8/6) Full Price On - Site ATRA Member ATRA Student Member Professional Non - Member Student Non - Member $400 $180 $550 $275 $430 $195 $570 $280 Daily Package Sun 9/16 (fee is per day) Fri 9/14 Sat 9/15 $170 $90 $275 $170 **Full Price After 8/6/2018** Step 2 - Would You Like to Add a Pre-Conference, CEUs, or a Hotel Lunch Voucher? Pre-Conference Institutes, CEUs and boxed lunches are NOT included in the full package registration fees above. $110 Full Day Pre - Con | Aquatics Careplan 1/2 Day Pre - Con AM | Exploring the Labyrinth: An EBP Mindfulness Intervention Full Day Pre - Con | Playing to Heal Full Day Pre - Con | Preparing Self-Study ATRA MEMBER NON MEMBER 1/2 Day Pre - Con AM | SOP & Educator's Tool ATRA Member ATRA Student Member Professional Non - Member Student Non - Member CEUs $30 Member $40 Non - Member Hotel Lunch Voucher $15 Thursday: 9/13 Voucher $15 Friday: 9/14 Voucher $15 Saturday: 9/15 Voucher $15 Sunday" 9/16 Voucher 1/2 Day Pre - Con AM | PeaceLove Approach 1/2 Day Pre - Con AM | The Sacred Circle 1/2 Day Pre - Con PM | How Do I Ensure That My RT Program Is Covered $110 $60 $60 $60 $60 $60 $60 FREE FREE $60 $60 $60 $60 FREE FREE 1/2 Day Pre - Con PM | Strength of Smell $60 $60 1/2 Day Pre - Con PM | Promote Healing Through EBP $60 $60 1/2 Day Pre - Con PM | Navigating Changes in Healthcare $60 $60

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Transcript of R e g i s t r a t i o n F o r m On-Site G r a n d R a p i ......Title: Mail in Registration Form...

Page 1: R e g i s t r a t i o n F o r m On-Site G r a n d R a p i ......Title: Mail in Registration Form 8.1.18 Author: albrechtle Keywords: DAC_IKkzI9o Created Date: 20180801161620Z

On-Site Registration Form

ATRA Annual Conference 2018 Grand Rapids , MI September 13 – 16 2018

$360$180$510$275

Yes

Badge: Full Name

Organization

CTRS? No Other Credentials

Badge City & State

Mailing Address

Mail - In & On - Site Registrat ion Form

City, State, Zip

Phone E-Mail

Step 1 - Select Your Registrat ion Package | Ful l Conference or Dai ly Rate

Ful l Conference Package Early Bird (Unti l 8/6) Ful l Pr ice On - Site

ATRA MemberATRA Student MemberProfessional Non - MemberStudent Non - Member

$400$180$550$275

$430$195$570$280

Dai ly Package Sun 9/16(fee is per day) Fri 9/14 Sat 9/15

$170$90$275$170

**Ful l Pr ice After 8/6/2018**

Step 2 - Would You Like to Add a Pre-Conference , CEUs , or a Hotel Lunch Voucher?Pre-Conference Inst i tutes , CEUs and boxed lunches are NOT included in the ful l package registrat ion fees above .

$110Full Day Pre - Con | Aquatics Careplan

1/2 Day Pre - Con AM | Exploring the Labyrinth: An EBP Mindfulness Intervention

Full Day Pre - Con | Playing to Heal

Full Day Pre - Con | Preparing Self-Study

ATRA MEMBER NON MEMBER

1/2 Day Pre - Con AM | SOP & Educator's Tool

ATRA MemberATRA Student MemberProfessional Non - MemberStudent Non - Member

CEUs$30 Member$40 Non - Member

Hotel Lunch Voucher$15 Thursday : 9/13 Voucher$15 Fr iday : 9/14 Voucher$15 Saturday : 9/15 Voucher$15 Sunday" 9/16 Voucher

1/2 Day Pre - Con AM | PeaceLove Approach

1/2 Day Pre - Con AM | The Sacred Circle

1/2 Day Pre - Con PM | How Do I Ensure That My RT Program Is Covered

$110

$60 $60$60 $60

$60 $60

FREE FREE

$60 $60

FREE FREE

1/2 Day Pre - Con PM | Strength of Smell $60 $60

1/2 Day Pre - Con PM | Promote Healing Through EBP $60 $60

1/2 Day Pre - Con PM | Navigating Changes in Healthcare

$60 $60

Page 2: R e g i s t r a t i o n F o r m On-Site G r a n d R a p i ......Title: Mail in Registration Form 8.1.18 Author: albrechtle Keywords: DAC_IKkzI9o Created Date: 20180801161620Z

Step 3 - Method Of Payment

Check or Money Order (Payable in US Dol lars) Purchase Order #______________

Credit/Debit Card Visa Mastercard American Express Discover

Name on Card

Billing Address

City

Card #

Exp. Date

State Zip

CVC Code

Signature

American Therapeutic Recreation Association (ATRA) 11130 Sunrise Valley Drive | Suite 350 | Reston, VA 20191

PLEASE REMIT PAYMENT VIA MAIL TO

[email protected]

PLEASE REMIT PAYMENT VIA EMAIL

703.435.4390

REMIT PAYMENT VIA FAX

Phone Number

Billing Address Cont.

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