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2010 APSE Annual Conference Registration Form

First name:

Last name:

Job title:

Agency:

Address 1:

Address 2:

City:

State:

Zip:

Country:

Phone:

Fax:

Email:

Web site:

APSE membership #:

If you are registering as a non-member, please leave this field blank.

Members, if you do not know your membership number, you can have it emailed to you.

Would you like to add your name to the list of registrants who are looking for a roommate at the conference?

Yes
No

Please check the option that best describes you:

Job Coach / Job Developer
Agency Director
K-12 Educator
University Staff / Researcher
Employer
Family Member
Individual with a Disability
Other (please specify: )

How did you hear about this conference?

APSE web site
Internet search engine
Conference registration flyer
Save the Date card
Email
At a conference (please specify: )
Co-worker / friend / employer
Other (please specify: )

Please tell us if you have any disability-related accommodation needs (e.g. sign language interpretation, Braille or large-print materials, etc.). All requests must be made by May 7, 2010.

Please tell us if you have any special dietary needs that we should know about as we plan coffee breaks, receptions, etc. All requests must be made by May 7, 2010.

Conference Fees Schedule

	Early Registration before April 15, 2010		Regular Registration April 16 - May 23, 2010		Late Registration May 24 - June 10, 2010
	APSE Member	Non-Member	APSE Member	Non-Member	APSE Member	Non-Member
Individual	$295	$405	$340	$450	$365	$495
Supported Employee / Family Member	$170	$200	$185	$225	$205	$250

Please Note: Individual rates are intended for anyone who works in the supported employment, rehabilitation, or related fields.

Participant Rate

Please choose the option that best describes you.

Individual, APSE member ($295)
Individual, APSE non-member ($405)
Supported Employee / Family Member, APSE member ($170)
Supported Employee / Family Member, APSE non-member ($200)

Other Rates:

Conference Sponsorships

If you would like to be a conference sponsor, please click the radio button corresponding to your desired level of sponsorship.

$25,000: Platinum Sponsor
$10,000: Gold Sponsor
$5,000: Silver Sponsor
$2,500: Bronze Sponsor
$1,500: Hotlanta Sponsor

Conference Booklet Ads

If you would like to place an ad in the conference booklet, please click the radio button corresponding to your desired type of ad.

$500 Full Page Ad (7.5" width by 10" height)
$350 Half Page Ad (4.5" width by 7" height)
$200 Quarter Page Ad (3.5" width by 4.5" height)
$250 Bag Insert - includes your organization's promotional materials in each attendee's bag. Items may include pens, note pads, or any advertising material for your agency. One promotional item per bag.

Exhibitor Fees

Sponsor and Exhibitor Prospectus

If you would like an exhibit booth at the conference, please choose from the following options:

Standard rate:

2 days: $575
1 day: $525

Non-profit / government rate:

1 or 2 days: $500

Supported entrepreneur rate:

2 days: $150
1 day: $125

Awards Luncheon: Wednesday, June 9

I will attend the luncheon on Wednesday, June 9, included in registration fee.

You may also bring guests to the awards luncheon for $40 per person.

Number of dinner guests I am bringing

Vegetarian meal requested.

APSE Membership Breakfast: Thursday, June 10

I will attend the APSE membership breakfast on Thursday morning, included in registration fee.

APSE Employment Institute (formerly SE 101)

Please register me for the APSE Employment Institute. I understand that registration is limited, that these sessions run concurrent to the other break out sessions, and that I will be expected to attend all APSE Employment Institute sessions.

APSE Federal ID: 54-1470501

For more information:
Jenny Levet at 804-278-9187.

451 Hungerford Drive, Ste. 700 Rockville, MD 20850 | Phone: 804.278.9187 | Fax: 804.278.9377 | Contact Us