Participant Information (Please print clearly.)Registration Deadline: March 14, 2001
| Name: | ||
| Title: | ||
| Name you prefer on name badge: | ||
| Organization: | ||
| Address: | ||
| City: | State: | Zip: |
| Phone: | Voice_____ | TTY ______ |
| Fax: | E-mail: | |
| Other than sign language interpreters
and realtime captioning, please indicate accessibility/accommodation requests
for the conference (e.g., Braille, close vision interpreting) (Deadline
for requests: March 21)
|
||
| I will be attending the WOU Rehabilitation Counseling Program Reunion, Thursday evening, April 5. | Yes _____ | No _____ |
| Please indicate your first and second preference for the Wednesday, April 4 all-day specialty workshop. Conference attendees will attend only ONE of these all-day workshops. | ||
| _____ Serving Individuals who are Deaf-Blind | ||
| _____ Serving Individuals who are Hard of Hearing | ||
| _____ Serving Individuals in the Deaf Native American Community | ||
$250 Conference Fees (Wednesday, Thursday, Friday)
(includes Wednesday Specialty Workshop; Conference Sessions Thursday and Friday;
no-host reception Wednesday; continental breakfasts; and lunches)
$150 Specialty Workshop Only (Wednesday Only)
(Includes Wednesday Specialty Workshop; lunch; no-host reception Wednesday evening)
$200 Student Registration (also includes meals and reception)
For full-time graduate or undergraduate students only.
Faculty signature (required): ___________________________
School and Department: _______________________________
$275 Late Registration (After March 14, if space is available.)
______ Total Amount Enclosed (Check, Money Order, or Purchase Order)Please make checks to: Regional Resource Center on Deafness/Western Oregon University
Mail completed registration form and payment to:
Regional Resource Center on Deafness
Western Oregon University
345 N. Monmouth Ave.
Monmouth OR 97361
ATTN: Becky Graber