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R e g i s t r a t i o n F o r m On-Site R e n o , N e v a d a Registration … · 2019-07-30 ·...

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On-Site Registration Form ATRA Annual Conference 2019 Reno, Nevada September 14 – 17, 2019 $390 $180 $550 $275 Yes Badge: Full Name Organization CTRS? No Other Credentials Badge City & State Mailing Address Mail - In & On - Site Registration Form City, State, Zip Phone E-Mail Step 1 - Select Your Registration Package | Full Conference or Daily Rate Full Conference Package Early Bird (Until 8/6) Full Price On - Site ATRA Member ATRA Student Member Professional Non - Member Student Non - Member $430 $180 $590 $275 $460 $195 $610 $280 Daily Package Mon 9/16 (fee is per day) Sat 9/14 Sun 9/15 $200 $90 $315 $170 **Full Price After 8/6/2019** Step 2 - Would You Like to Add a Pre-Conference to Your Registration? Pre-Conference Institutes are NOT included in the full package registration fees above. $180 FREE $160 $160 $140 $140 FREE $90 FREE $90 $90 Full Day Pre - Con | Intro to Aquatic Therapy Full Day Pre - Con | Virtual Reality in RT Full Day Pre - Con | CARTE ATRA MEMBER NON MEMBER ATRA Member ATRA Student Member Professional Non - Member Student Non - Member Full Day Pre - Con | Standards of Practice Full Day Pre - Con | Bridging the Gap: Clinical Independence 1/2 Day Pre - Con AM | Section Leaders & Leadership Development 1/2 Day Pre - Con AM | Dare Model for Clinical Supervision 1/2 Day Pre - Con AM | RT & SLP with ABI STUDENT $140 FREE $130 $130 $75 $75 FREE $60 FREE $60 $60 $190 FREE $170 $170 $170 $170 FREE $100 FREE $100 $100 Full Day Pre - Con | Role Playing Games Full Day Pre - Con | RT Influencer / Social Media Full Day Pre - Con | Inclusion - Parks & Recreation **CONFERENCE CEUs ARE INCLUDED WITH FULL REGISTRATION** Tues 9/17
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Page 1: R e g i s t r a t i o n F o r m On-Site R e n o , N e v a d a Registration … · 2019-07-30 · Title: 2019 Mail in Registration Form - RENO Author: albrechtle Keywords: DAC_sRW8PTY,BAA3NpBj-Q4

On-Site Registration Form

ATRA Annual Conference 2019 Reno , Nevada September 14 – 17 , 2019

$390$180$550$275

Yes

Badge: Full Name

Organization

CTRS? No Other Credentials

Badge City & State

Mailing Address

Mail - In & On - SiteRegistrat ion Form

City, State, Zip

Phone E-Mail

Step 1 - Select Your Registrat ion Package | Ful l Conference or Dai ly Rate

Ful l Conference Package Early Bird (Unti l 8/6) Ful l Pr ice On - Site

ATRA MemberATRA Student MemberProfessional Non - MemberStudent Non - Member

$430$180$590$275

$460$195$610$280

Dai ly Package Mon 9/16(fee is per day) Sat 9/14 Sun 9/15

$200$90$315$170

**Ful l Pr ice After 8/6/2019**

Step 2 - Would You Like to Add a Pre-Conference to Your Registrat ion?

Pre-Conference Inst i tutes are NOT included in the ful l package registrat ion fees above .

$180

FREE$160

$160

$140

$140

FREE

$90

FREE

$90

$90

Full Day Pre - Con | Intro to Aquatic Therapy

Full Day Pre - Con | Virtual Reality in RT

Full Day Pre - Con | CARTE

ATRA MEMBER NON MEMBER

ATRA MemberATRA Student MemberProfessional Non - MemberStudent Non - Member

Full Day Pre - Con | Standards of Practice

Full Day Pre - Con | Bridging the Gap: Clinical Independence

1/2 Day Pre - Con AM | Section Leaders & Leadership Development

1/2 Day Pre - Con AM | Dare Model for Clinical Supervision

1/2 Day Pre - Con AM | RT & SLP with ABI

STUDENT$140

FREE

$130

$130

$75

$75

FREE

$60

FREE

$60

$60

$190

FREE$170

$170

$170

$170

FREE

$100

FREE

$100

$100

Full Day Pre - Con | Role Playing Games

Full Day Pre - Con | RT Influencer / Social Media

Full Day Pre - Con | Inclusion - Parks & Recreation

**CONFERENCE CEUs ARE INCLUDEDWITH FULL REGISTRATION**

Tues 9/17

Page 2: R e g i s t r a t i o n F o r m On-Site R e n o , N e v a d a Registration … · 2019-07-30 · Title: 2019 Mail in Registration Form - RENO Author: albrechtle Keywords: DAC_sRW8PTY,BAA3NpBj-Q4

Step 3 - Method Of Payment

Check or Money Order (Payable in US Dol lars) Purchase Order #______________

Credit/Debit Card Visa Mastercard American Express Discover

Name on Card

Billing Address

City

Card #

Exp. Date

State Zip

CVC Code

Signature

American Therapeutic Recreation Association (ATRA) ATTN: Conference Planning 11130 Sunrise Valley Drive | Suite 350 Reston, VA 20191

PLEASE REMIT PAYMENT VIA MAIL TO

[email protected]

NEED TO REMIT PAYMENT VIA EMAIL?

Phone Number

Billing Address Cont.


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