Date:

Name (First, Last):

2nd Attendee's Name (First, Last):

Organization:

Address:

City: State: Zip Code:

Phone: Home: Cell:

Work: Fax:

Email address:

Please Check All That Apply: I am a: Parent /Family Member Parent Professional (a parent/familiy member of a child w/

disabilities working in disability profession) Foster Parent Professional Conference Speaker Exhibitor Sponsor

If you need an invoice for a Purchase Order, please call or email Sue Regimbal (512-458-6001; 866-896-6001; sue@txp2p.org) to request one. Please provide her with the organization's name and address, the name of the person registering, a phone number, and a fax number or fax your Purchase Order to Sue Regimbal, TxP2P, at 512-451-3110 - this is a shared fax so please use a cover sheet..

To register by mail fill out and mail the form (below) with a check made payable to Texas Parent to Parent, 3710 Cedar Street, Box 12, Austin, TX  78705-1449.

_______________________________________________________________________________________________

Please check all that applies:

I/We will be attending: Friday Saturday

I/We will be eating lunch: Friday Saturday

I/We need child care (fill out enclosed registration form): Yes No Friday Saturday

I/We will be attending the Family Gathering on Friday night (professionals are welcome - space is limited to 350) Yes No

My 10-18 year old child (children) will participate in the SibGroup SS1 on Friday (fill out enclosed registration form)
Yes No

My 7-9 year old child (children) will participate in the SibGroup SS3 on Saturday (fill out enclosed registration form)
Yes No

My 10-12 year old child (children) will participate in the SibGroup SS5 on Saturday (fill out enclosed registration form)
Yes No

My 13 - 22 year old teen/youth will attend the Teen Transition Expo SS2 on Saturday (fill out enclosed registration form)
Yes No

I/We need special accommodations: Yes, please list: No

NO LONGER AVAILABLE I/We would like to apply for a Parent Registration Stipend (fill out enclosed application form)
I would like to volunteer to help at the conference and receive a reduced registration fee (you cannot receive a Parent Registration Stipend - see above - and a Volunteer Stipend - you must choose one or the other):

1st Attendee:
Conference registration (7a.m. - 9 a.m. Friday & Saturday)
Session Facilitator (introduces speaker, distributes & collects evaluations & CEU paperwork) 3 sessions 5 sessions
Sign Language Interpretation
Spanish Language Interpretation

2nd Attendee:
Conference registration (7a.m. - 9 a.m. Friday & Saturday)
Session Facilitator (introduces speaker, distributes & collects evaluations & CEU paperwork) 3 sessions 5 sessions
Sign Language Interpretation
Spanish Language Interpretation

NO LONGER AVAILABLE I/We would like to apply for a Parent Hotel Stipend (fill out enclosed application form) Yes No

I need an interpreter: Sign Language Spanish

I would like to make Tax Deductible Contribution to Texas Parent to Parent Yes No Amount:

I would like to help pay another parent’s/family’s conference expenses Yes No Amount:

_________________________________________________________________________________________________

PARENT STIPEND REQUEST: NO LONGER AVAILABLE

I/We are the parent(s) (or other family member) of a child with a disability, chronic illness or other health care need.

I would like to request a stipend for (limited number available):

Conference Registration Stipend ($30 per parent/family member): How many adults requesting stipends:

Hotel Stipend (maximum $85 per night for 2 people per room - only available for the Omni):
How many adults requesting stipends: 1 night 2nights

I/we will not be able to attend the conference without stipends.

I/we did not receive a stipend for the Texas Parent to Parent State Conference in 2007.

_________________________________________________________________________________________________

Child Size: Small - how many: Medium - how many: Large - how many:

Adult Size: Small - how many: Medium - how many: Large - how many:

XLarge - how many: XXLarge - how many:

Total number: x $10.00 =

_______________________________________________________________________________________________________

SIBSHOP REGISTRATION FORM:

Name (First, Last):

Age: Other information:

Name (First, Last):

Age: Other information:

Name (First, Last):

Age: Other information:

______________________________________________________________________________________________________

TEEN TRANSITION EXPO REGISTRATION FORM:

Teen #1 Name (First, Last):

Teen's email:

Teen's phone #:

Teen #2 Name (First, Last):

Teen's email:

Teen's phone #:

______________________________________________________________________________________________________

CHILD CARE REGISTRATION FORM:
Child care is limited and requires a $25 fee. Spaces will be reserved based on the date that completed registrations (all
applicable documents and full payment) are received. We hope to accommodate everyone. We will hire child care workers
who have experience working with children with disabilities, chronic illness and other health care needs, but we cannot
guarantee that they will be able to do special procedures, tube feeding or administer medication.
Please give the name and age of each child. Please include any information about your child that the child care workers need to know.

Child's #1 Name (First, Last):

Age:
Accommodations/Needs:

Child's Name #2 (First, Last):

Age:
Accommodations/Needs:

Child's Name #3 (First, Last):

Age:
Accommodations/Needs:

Child's Name #4 (First, Last):

Age:
Accommodations/Needs:

______________________________________________________________________________________________________

SELECT SESSIONS FOR ATTENDEE #1 (Select only ONE Title Per Session):

Session 1 (Friday, 10:30 am- 12:00 pm):

TX Dept of State Health Services: Focus Group 1 (12:15 - 1:15 p.m.)

Session 2 (Friday, 1:30 pm- 3:00 pm):

201 - It’s Time to Make A Difference...Legislative Advocacy 202 202 - The New Autism Addendum 203 - Explosive Behavior in Children:  Finding their Triggers and Preventing Meltdowns 204 - Accessing SSI & Medicaid for Students with Disabilities:  Opportunities for Funding Transition (Part 1 of 2) 206 - Panel:  Serious Mental Illnesses in Children & Teenagers 207 - Planning Pays! 208 - Recursos Que Cada Padre Debe Conocer: Ayudando a Nuestros Hijos con Discapacidades Vivir Una Vida Enriquecida y Con Seguridad 209 - Texas Complaint Resolution Process 210 - TransitionS Planning:  If Not Now...When?

Session 3 (Friday, 3:30 pm- 5:00 pm):

TX Dept of State Health Services: Focus Group (5:15 - 6:15 p.m.)

Early Bird Session (4) (Saturday, 8:30 am- 10:00 am):

Session 5 (Saturday, 10:30 am - 12:00 am):

TX Dept of State Health Services: Focus Group 3 (12:15 - 1:15 p.m.)

Session 6 (Saturday, 1:30 pm - 3:00 pm):

Session 7 (Saturday, 3:30 pm - 5:00 pm):

SELECT SESSIONS FOR ATTENDEE #2 (Select only ONE Title Per Session):

Session 1 (Friday, 10:30 am- 12:00 pm):

TX Dept of State Health Services: Focus Group 1 (12:15 - 1:15 p.m.)

Session 2 (Friday, 1:30 pm- 3:00 pm):

201 - It’s Time to Make A Difference...Legislative Advocacy 202 202 - The New Autism Addendum 203 - Explosive Behavior in Children:  Finding their Triggers and Preventing Meltdowns 204 - Accessing SSI & Medicaid for Students with Disabilities:  Opportunities for Funding Transition (Part 1 of 2) 206 - Panel:  Serious Mental Illnesses in Children & Teenagers 207 - Planning Pays! 208 - Recursos Que Cada Padre Debe Conocer: Ayudando a Nuestros Hijos con Discapacidades Vivir Una Vida Enriquecida y Con Seguridad 209 - Texas Complaint Resolution Process 210 - TransitionS Planning:  If Not Now...When?

Session 3 (Friday, 3:30 pm- 5:00 pm):

TX Dept of State Health Services: Focus Group 2 (5:15 - 6:15 p.m.)

Early Bird Session (4) (Saturday, 8:30 am- 10:00 am):

Session 5 (Saturday, 10:30 am - 12:00 am):

TX Dept of State Health Services: Focus Group 3 (12:15 - 1:15 p.m.)

Session 6 (Saturday, 1:30 pm - 3:00 pm):

Session 7 (Saturday, 3:30 pm - 5:00 pm):

REGISTRATION TOTALS: Please do not pay until you receive a confirmation from us with the amount due. We will email you within 3 working day after receiving your registration form.

Registration:

Late Parent/Family Member/Parent Professional $95
Late Parent Professional with CEU or Foster Parent with attendance form $120
Late Professional without CEU $120
Late Professional with CEU $145
Conference Speaker (No charge)
Conference Speaker with CEU $25
Exhibitor (No charge)
Sponsor (No charge)

CONFERENCE REGISTRATION TOTAL:

T-SHIRT TOTAL:

CHILD CARE/SIBGROUP ($25.00 fee):

TEEN TRANSITION EXPO ($25.00 fee):

TAX-DEDUCTIBLE CONTRIBUTION:

FAMILY EXPENSES CONTRIBUTION:

TOTAL ENCLOSED:

PLEASE DO NOT PAY YOUR REGISTRATION FEES UNTIL YOU HAVE HEARD FROM THE TxP2P REGISTRAR WITH THE AMOUNT DUE. WE WILL CONTACT YOU WITHIN 3 WORKING DAYS AFTER RECEIVING YOUR REGISTRATION. THANKS!!

I will send a check to Texas Parent to Parent, 3710 Cedar Street, Box 12, Austin, Tx 78705

I will pay for my registration via credit card using Network for Good or will call TxP2P with my info (512-458-8600 or toll-free 866-896-6001).

PLEASE PRINT THIS PAGE BEFORE HITTING SUBMIT - YOU WON'T HAVE ANOTHER CHANCE.