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) Parent Professional w/o CEUs Self-Advocate Foster Parent
Professional w/ CEUs Professional w/o CEUs Conference Speaker Exhibitor Sponsor

If you need an invoice for a Purchase Order, please email Sue Regimbal (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. You can also
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 (Additional Registration Form Required): Yes No Friday Saturday WAITING LIST

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

My 7-9 year old child (children) will participate in the SibGroup SS1 on Saturday (Additional Registration Form Required)
Yes No

My 10-12 year old child (children) will participate in the SibGroup SS2 on Saturday CLOSED

My 13 - 22 year old teen/youth will attend the Teen Transition Expo SS3 on Saturday (Additional Registration Form Required)
Yes No

I need an interpreter: Sign Language Spanish

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

If you would like to volunteer to help with Sign Language Interpretation or Spanish Language Interpretation at the conference,
please contact Laura Warren at Laura@txp2p.org or call 866-896-6001 or 512-458-8600.

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PARENT STIPEND REQUEST: WE HAVE GIVEN OUT ALL THE HOTEL STIPENDS AND HAVE MANY PEOPLE ON THE WAITING LIST SO WE DOUBT THAT WE WILL HAVE ANY MORE HOTEL STIPENDS FOR THIS CONFERENCE.

I/We would like to apply for a Parent Registration Stipend (see below for additional information needed) Yes No

I/We would like to apply for a Parent Hotel Stipend (see below for additional information needed) CLOSED

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

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

I am requesting a stipend for the Conference Registration Fee (maximum $25 per parent/family member): How many adults requesting stipends:

CLOSED I am requesting a Hotel/Lodging Stipend (maximum $85 per night for 2 people per room - only available for the Omni):
How many adults requesting stipends: For 1 night or 2nights

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

CLOSED I/we did not receive a stipend for the Texas Parent to Parent State Conference in 2008.

CLOSEDI live more than 70 miles away from the Omni Austin Hotel at Southpark

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

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

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

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

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

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):

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

201 - Inclusive Congregation Program
202 - Social Thinking for Students with Autism
204 - Accessing SSI and Medicaid for Students with Disabilities: Opportunities for Funding Transition
Part 1 of 2 (Double Session)
204A - Care for the Caregiver
204B - Special Needs Planning for Special Needs Kids
206 - Diagnosis, Classification & Treatment of Psychopathology in Infants and Toddlers
208 - Learning Health Care Self-Advocacy
208A - What Self-Advocacy Is and Is Not
210 - Advocating 101
212 - How to cut your meat, do laundry and perform chores with unreliable vision

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

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

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

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

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

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FREE T-SHIRTS - Please indicate how many of each size: T-SHIRTS HAVE BEEN ORDERED; WE ORDERED EXTRA IN AN ATTEMPT TO ENSURE THAT ALL PARTICIPANTS CAN RECEIVE ONE. YOU MAY STILL SELECT A SIZE HOWEVER WE CANNOT GUARANTEE WE WILL HAVE THE SIZE YOUR REQUEST.

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:

____________________________________________________________________________________________________

ADDITIONAL T-SHIRTS TO PURCHASE - Please indicate how many of each size: NO LONGER AVAILABLE - ANY EXTRA T-SHIRTS WE HAVE WILL BE ON SALE AT THE CONFERENCE.

____________________________________________________________________________________________________

Registration fees (Please check which one applies to you):

Parent /Family Member/Parent Professional/Self-Advocate w/o CEUs - $105 per person

Parent Professional w/ CEUs or Foster Parent w/ Attendance Form - $125 per person

Professional w/o CEUs - $135 per person

Professional w/ CEUs - $160 per person

Self-Advocate - Teen Expo only - $30

Conference Speaker/Exhibitor/Sponsor - no additional cost

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:

____________________________________________________________________________________________________

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

After you submit this page, you will have the opportunity to sign up children for child care and/or sibling groups and pay for your registration.