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
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
NEED TO REMIT PAYMENT VIA EMAIL?
Phone Number
Billing Address Cont.