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2008 APSE Annual Conference Registration Form

First name:

Last name:

Job title:

Agency:

Address 1:

Address 2:

City:

State:

Zip:

Phone:

Fax:

Email:

APSE membership number:

I am (please check all that apply):

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 June 20, 2008.

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 June 20, 2008.

Conference Fees Schedule

	Early Registration before June 1, 2008		Regular Registration June 1 - June 30, 2008		Late Registration July 1 - July 18, 2008
	APSE Member	Non - Member	APSE Member	Non - Member	APSE Member	Non - Member
Professional	$290	$400	$335	$445	$360	$470
Non-Professional	$165	$195	$180	$220	$200	$245

Please Note: Professional rates are intended for anyone who works in the supported employment, rehabilitation, or related fields. Non-professional rates are for supported employees, non-professional family members, students, and others.

Other Rates:

Conference Sponsorships

$25,000
$10,000
$5,000
$2,500
$1,000
$500
$250

Conference Booklet Ads

$500 Full Page Ad
$350 Half Page Ad
$200 Quarter Page Ad
$250 Bag Insert
$500 Larger Materials

Exhibit Booth

$450

You may also bring guests to the Awards Dinner on Tuesday night for $40 per person.

Conference Payment

If you need help calculating your conference fees or have other questions, contact Gracie at 804-278-9187.

1. Using the above table determine your conference fee and enter it here:	$
2. Add any of the following that apply:
Conference Sponsorship:	$
Advertising:	$
Exhibit Booth:	$
Dinner Guests:	$ @ $40 each
Total:	$0

I am paying by:

Check (payable to APSE)
Purchase Order ( number: )
Credit Card

To make credit card payment, please call the APSE office at 804-278-9187 or fax your credit card information to 804-278-9377.

I will attend the dinner on Tuesday night, included in registration fee

Vegetarian meal requested

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

Please register me for SE 101 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 SE 101 sessions.

APSE Federal ID: 54-1470501

For more information:
Gracie Burwell, 804-278-9187, gracie@apse.org