Child Life Council Twentieth Annual Conference On Professional ...
Child Life Council Twentieth Annual Conference On Professional ...
Child Life Council Twentieth Annual Conference On Professional ...
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<strong>Conference</strong> Registration Form<br />
Please complete both sides of the form. Make checks payable and mail to:<br />
2002 <strong>Annual</strong> <strong>Conference</strong> • <strong>Child</strong> <strong>Life</strong> <strong>Council</strong> • 11820 Parklawn Drive, Suite 202 •<br />
Rockville, MD 20852-2529<br />
Name __________________________________________ Maiden____________________________<br />
Title_______________________________ Hospital/Institution________________________________<br />
Mailing Address ❏ Home ❏ Work<br />
Street_____________________________________________________________________________<br />
City ___________________________State/Prov.___________ Zip/Postal Code__________________<br />
Daytime Phone____________________________ Email_____________________________________<br />
I have attended conference for<br />
❏ First year ❏ 2-5 years ❏ 6-10 years ❏ 11-15 years ❏16-20 years<br />
❏ I will attend the Meet the Board & Candidates Reception (Thursday, 8:00 - 9:00 pm )<br />
❏ I will volunteer to work a few hours at the <strong>Conference</strong>.<br />
❏ I will be signing up for therapeutic recreation CEUs<br />
❏ I do not want my name on conference attendance list available at CLC Hospitality<br />
❏ I would be willing to review and rate proposals for the 2003 conference presentations.<br />
❏ I will require the following special services to fully participate in the conference:___________________<br />
_____________________________________________________________________________________<br />
Session Choices<br />
Please indicate which sessions you would like to attend. Admission to all sessions is on a first-come,<br />
first-served basis. Name tags will be required for admission to all sessions.<br />
Friday<br />
Saturday (continued)<br />
3:45 – 5:15 pm Workshops 2 - 7<br />
Choice #_____<br />
OR<br />
3:45 – 5:45 pm 2-hour Intensive 8 - 10<br />
Choice #_____<br />
6:00 – 7:00 pm Networking<br />
Pick top four choices in order<br />
1___ 2___ 3___ 4____<br />
I will attend the Opening Reception ❏Yes ❏No<br />
Saturday<br />
1:45 – 3:15 pm Workshops 20 – 27<br />
Choice # _____<br />
4:45 – 6:00 pm Committee Working Sessions<br />
A - L _____<br />
Sunday<br />
8:30 – 10:30 am Workshops 28 – 30<br />
Choice #______<br />
OR<br />
8:30 – 9:30 a.m Workshops 31 – 34<br />
Choice #______<br />
I will attend the Continental Breakfast ❏Yes ❏No<br />
I will attend Certification Round Table ❏Yes ❏No<br />
I will attend All Members Meeting I ❏Yes ❏No<br />
11:15 am – 12:15 pm Workshops 11 – 19<br />
Choice #______<br />
Over Please ►<br />
9:45 – 10:45 a.m. Workshops 35 – 39<br />
Choice #______<br />
I will attend All Members Mtg. II<br />
❏ Yes ❏ No<br />
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