Registration Form

Your Name(s) (required)

Your Email (required)

Phone Number (required)

Childs Condition (optional)

Childs Age (optional)

11:30 Breakout (Choose One) (required)
 A: Health Insurance B: Let's Get Organized

1:15 Breakout (Choose One) (required)
 A: Genetics 101 B: Financial Planning

2:15 Breakout (Choose One) (required)
 A: Finding PCAs B: Home & Vehicle Modification

Payment Options
Cost is $20/person or $30/couple
Payments must be received by May 1, 2008

Choose Payment Options
 I will pay by check I will pay online with Paypal

Directions on how to pay for the conference will be included in an email you will be sent after you register. Please be sure to provide your correct and working email address. You will be able to pay by check or online via Paypal.

Accommodations for Children
Unfortunately we are unable to accommodate children at this year’s conference. We hope to change that next year. We apologize for any inconvenience.