Summer 2012 - Madison Cortland ARC

____ @ $50pp = $____________ PAYMENT INFORMATION
_________________________________________________________
_____@ $75pp = $____________ __ Check # ______ (Made payable to HARC)
_________________________________________________________
OVERNIGHT ACCOMMODATIONS - PAY SEPARATELY
FOR RESERVATIONS CONTACT: VERNON DOWNS CASINO HOTEL
gistration Form:
Call 1-315-829-3400 ext. 2173 for a special group rate by Sept.1, 2012.
atly. List each attendee. Coming Photocopy Sept. as needed • Registration 24, Reserve Deadline - September Your 14, 2012 Spot!
Indicate: ARC Autism Conference. Reservations Conference will be accepted
C, Attn: Public Relations, PO Box 271, Herkimer, NY 13350
Registration Form:
subject to availability at the prevailing rate. Please type or print neatly. List each attendee. Photocopy as needed • Registration Deadline - September 14, 2012
_________________________ I am ___Family Member ($50) ___ NYSARC Staff ($75) ____Teacher/Professional ($125)
“Ziggurat Model” and
Print & mail to: HARC, Attn: Public Relations, PO Box 271, Herkimer, NY 13350
_________________________ I am ___Family Member ($50) ___ NYSARC Staff ($75) ____Teacher/Professional ($125)
Name: _______________________________________ I am ___Family Member ($50) ___ NYSARC Staff ($75) ____Teacher/Professional ($125)
_________________________ “Hidden I am ___Family Member Curriculum: ($50) ___ NYSARC Staff ($75) Practical
____Teacher/Professional ($125)
Name: _______________________________________ I am ___Family Member ($50) ___ NYSARC Staff ($75) ____Teacher/Professional ($125)
_________________________ Solutions I am ___Family for Member Understanding ($50) ___ NYSARC Staff ($75) ____Teacher/Professional Rules in ($125)
Together we are building futures
Name: _______________________________________ I am ___Family Member ($50) ___ NYSARC Staff ($75) ____Teacher/Professional ($125)
des lunch on September 24
Social Situations”
th ____@ $125pp = $___________
__ MasterCard or __ Visa (please indicate type of card) :
11 - Madison Cortland ARC - Summer 2012 WE ARE A TEAM
____________ Daytime Phone: _______________________________
Credit Card No.: _______ - _______ -_______ - _______
NT ENCLOSED: $_____________
_________________________________________________________
Exp. Date: _________
Conference Registration Form:
__________________________________________________
PAYMENT INFORMATION
Please type or print neatly. List each attendee. Photocopy as needed. Registration deadline: September 14, 2012
Name on Credit Card (please print)
__ Check # ______ (Made payable to
__________________________________________________
HARC)
Mail to: HARC, PO Box 271, Herkimer, NY 13350. Or call Carolyn Roy; 315-574-7780
__ MasterCard or __ Visa (please indicate
Cardholder’s
type of
Signature
card) :
(required for credit card)
Credit Card No.: _______ - _______ -_______
__________________________________________________
- _______
Exp. Date: _________
Cardholder’s Billing Address - City State Zip Code
__________________________________________________
Name on Credit Card (please . print)
OVERNIGHT ACCOMMODATIONS - PAY SEPARATELY
Name: _______________________________________ I am ___Family Member ($50) ___ NYSARC Staff ($75) ____Teacher/Professional ($125)
REGISTRATION FEE includes lunch on September 24th __________________________________________________
FOR RESERVATIONS CONTACT: VERNON DOWNS CASINO HOTEL
le): ______________________________________________________________________________________________
Cardholder’s Signature (required for credit card) “Ziggurat Model” & “Hidden Curriculum: Practical Solutions for
Call 1-315-829-3400 ext. 2173 for a special group rate by Sept.1, 2012.
.
Featuring: Dr. Brenda
_________________________________________________________________________________________________
__________________________________________________
Indicate: ARC featuring Autism Conference. Understanding Brenda Reservations Smith-Myles
Rules will be in accepted Social Situations”
Smith Myles
Organization (if applicable): ______________________________________________________________________________________________
_________________________
Cardholder’s Billing Address subject State:
- City to ______
State availability Zip
Zip:
Code
____________ at the prevailing Daytime rate. Phone: _______________________________
Brenda Smith Myles Ph.D., international speaker and consultant for the Ohio
Mailing Address: _______________________________________________________________________________________________________
________________________ Email Center Address: for Autism ___________________________________________________________
and Low Incidence, is the recipient of the Autism Society of Conference Schedule:
NIGHT ACCOMMODATIONS America’s - PAY Outstanding SEPARATELY Professional Award, the Princeton Fellowship Award,
City: _________________________________________ State: ______ Zip: ____________ Daytime Phone: _______________________________
Members: ESERVATIONS _______ CONTACT: @ $50pp VERNON = $____________ and DOWNS the Council CASINO for HOTEL PAYMENT Exceptional INFORMATION
Children, Division on Developmental Disabili- 8:30 a.m. - Dr. Brenda Myles
315-829-3400 ext. 2173 for a special ties group Burton rate Blatt by Humanitarian Sept.1, Award. Brenda has made over 500 presentations
Mobile: ______________________________________ Email Address: ___________________________________________________________
Staff: __________@ $75pp = $____________ __ Check 2012. # ______ (Made payable to HARC)
10:00 a.m. - Break
Together we are building futures
te: ARC Autism Conference. Reservations all over the will world be accepted and written more than 150 articles and books on ASD including
Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums,
10:15 a.m. Total - Dr. Number Brenda of Myles
s/Profs _________@ $125pp = $___________
__ MasterCard or __ Visa (please indicate type of card) :
ct to availability at the prevailing rate.
Family Members: _______ @ $50pp = $____________ PAYMENT INFORMATION
Rage, and Meltdowns Credit (with Card Southwick) No.: _______ and The - _______ Hidden -_______ Curriculum: - _______
“Ziggurat Practical 12:00 noon Total - Lunch
TOTAL AMOUNT Model” ENCLOSED: & “Hidden $_____________ Curriculum: Practical Solutions for
Number of NYSARC Staff: __________@ $75pp = $____________ __ Check # ______ (Made payable to HARC)
Solutions for Understanding Unstated rules in Social Situations. In addition, she served as the
Understanding 1:00 p.m. - Dr. Brenda Myles
Total Number of Teachers/Profs _________@ $125pp = $___________
__ MasterCard or __ Visa (please indicate type of card) :
co-chair Rules of the National in Social ASD Situations” Exp. Date: _________
Teacher Standards Committee and was on the National Institute of
__________________________________________________
Mental Health’s Interagency Autism Coordinating Committee’s Strategic Planning Consortium. 2:30 p.m. - Break
Credit Card No.: _______ - _______ -_______ - _______
yles Ph.D., international speaker and consultant for the TOTAL AMOUNT ENCLOSED: $_____________
Myles is also on the executive boards of Name Ohio
several on Credit organizations, Card (please including print) the Organization for
m and
2.45 p.m. - Dr. Brenda Myles
Exp. Date: _________
Together Low we are Incidence, building futures is the recipient of the Autism Society of Conference Schedule:
Autism Research, ASTEP – Asperger Syndrome __________________________________________________
Training and Education Program, and the Educa-
tanding Professional Award, the Princeton Fellowship Award,
4:00 p.m. - Conference Ends
__________________________________________________
tion and Treatment Services Project for Military Dependent Children with Autism. In addition, in the
l for Exceptional Children, Division on Developmental Disabili- Cardholder’s Signature 8:30 a.m. - (required Dr. Brenda for Myles credit card)
latest survey conducted by the University of Texas, she was acknowledged as the second most
Name on Credit Card (please print)
t Humanitarian den Curriculum: Award. Brenda Practical has made Solutions over 500 presentations for
productive applied researcher in ASD in __________________________________________________
10:00 a.m. - Break
ld and written more than 150 articles and books on ASD includ- the world.
Social Situations”
__________________________________________________
ndrome and Difficult Moments: Practical Solutions for Tantrums, Cardholder’s Billing 10:15 a.m. Address - Dr. Brenda - City State Myles Zip Code
Cardholder’s Signature (required for credit card)
downs
and consultant
(with Southwick)
for the Ohio
and The Hidden Curriculum: Practical 12:00 noon - Lunch
ted rules in Social Situations. In addition, she served as the
__________________________________________________
ient of the Autism Society of Conference Schedule: 1:00 p.m. - Dr. Brenda Myles
rinceton
er Standards
Fellowship
Committee
Award,
and was on the OVERNIGHT National Institute of ACCOMMODATIONS - PAY SEPARATELY
Cardholder’s Billing Address - City State Zip Code
Coordinating Committee’s Strategic Planning FOR RESERVATIONS Consortium. CONTACT:
2:30 p.m.
VERNON
- Break
on Developmental Disabili- 8:30 a.m. - Dr. Brenda Myles
DOWNS CASINO HOTEL
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10:00
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and the Educa-
Indicate: ARC Autism Conference. 4:00 p.m. - Conference Reservations Endswill
be accepted
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OVERNIGHT ACCOMMODATIONS - PAY SEPARATELY
ractical Solutions for Tantrums,
10:15 a.m. - Dr. Brenda Myles
iversity of Texas, she was acknowledged as subject the second to availability most at the prevailing rate.
FOR RESERVATIONS CONTACT: VERNON DOWNS CASINO HOTEL
Hidden Curriculum: Practical 12:00 noon - Lunch
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ddition,
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world.
served as the
Call 1-315-829-3400 ext. 2173 for a special group rate by Sept.1, 2012.
1:00 p.m. - Dr. Brenda Myles
s on the National Institute of
Indicate: ARC Autism Conference. Reservations will be accepted
egic Planning Consortium. 2:30 p.m. - Break
subject to availability at the prevailing rate.
ding the Organization for 2.45 p.m. - Dr. Brenda Myles
ation Program, and the Educa-
4:00 p.m. - Conference Together Ends we are building futures
with Autism. In addition, in the
ledged as the second most
da
“Ziggurat Model” & “Hidden Curriculum: Practical Solutions for
Understanding Rules in Social Situations”
Building Futures Foundation
nda Smith Myles Ph.D., international speaker and consultant for the Ohio
ter for Autism and Low Incidence, is the recipient of the Autism Society of
erica’s Outstanding Professional Award, the Princeton Fellowship Award,
the Council for Exceptional Please make Children, check Division payable on Developmental to Building Futures Disabili-Foundation.
8:30 a.m. - Dr. Brenda Myles
Burton Blatt Humanitarian Award. Brenda has made over 500 presentations 10:00 a.m. - Break
ver the world and ______ written more Please than 150 charge articles and my books credit on ASD includ- card:
Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums,
10:15 a.m. - Dr. Brenda Myles
e, and Meltdowns (with Southwick) and The Hidden Curriculum: Practical 12:00 noon - Lunch
nding Unstated ______ rules in Social Visa Situations. ______ In addition, she MasterCard
served as the
1:00 p.m. - Dr. Brenda Myles
l ASD Teacher Standards Committee and was on the National Institute of
gency Autism Coordinating Card # Committee’s ________________________________
Strategic Planning Consortium. 2:30 p.m. - Break
xecutive boards of several organizations, including the Organization for 2.45 p.m. - Dr. Brenda Myles
EP – Asperger Syndrome Training and Education Program, and the Educarvices
Project for Expiration Military Dependent date_______ Children with Autism. Amount In addition, in __________
4:00 p.m. - Conference Ends
the
d by the University of Texas, she was acknowledged as the second most
earcher in ASD in the world.
Enclosed is my gift of $__________________ Conference Schedule:
Signature_______________________________
Name__________________________________
Address ________________________________
_______________________________________
City ___________________________________
State __________ Zip_____________________
E-Mail _________________________________
_____ I wish to remain anonymous
_____ Contact me to volunteer
Your Gift is Tax-deductible.
Mail to
Building Futures Foundation
710 Lenox Ave., Oneida, NY 13421
www.madisoncortlandarc.org
Cardholder’s Billing Address - City State Zip Code
Featuring: Dr. Brenda
Smith Myles
Together we are building futures
“Ziggurat Model” & “Hidden Curriculum: Practical Solutions for
Understanding Rules in Social Situations”
Brenda Smith Myles Ph.D., international speaker and consultant for the Ohio
Center for Autism and Low Incidence, is the recipient of the Autism Society of
America’s Outstanding Professional Award, the Princeton Fellowship Award,
and the Council for Exceptional Children, Division on Developmental Disabilities
Burton Blatt Humanitarian Award. Brenda has made over 500 presentations
all over the world and written more than 150 articles and books on ASD including
Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums,
Rage, and Meltdowns (with Southwick) and The Hidden Curriculum: Practical
Solutions for Understanding Unstated rules in Social Situations. In addition, she served as the
co-chair of the National ASD Teacher Standards Committee and was on the National Institute of
Mental Health’s Interagency Autism Coordinating Committee’s Strategic Planning Consortium.
Myles is also on the executive boards of several organizations, including the Organization for
Autism Research, ASTEP – Asperger Syndrome Training and Education Program, and the Education
and Treatment Services Project for Military Dependent Children with Autism. In addition, in the
latest survey conducted by the University of Texas, she was acknowledged as the second most
productive applied researcher in ASD in the world.
Conference Schedule:
8:30 a.m. - Dr. Brenda Myles
10:00 a.m. - Break
10:15 a.m. - Dr. Brenda Myles
12:00 noon - Lunch
1:00 p.m. - Dr. Brenda Myles
2:30 p.m. - Break
2.45 p.m. - Dr. Brenda Myles
4:00 p.m. - Conference Ends