Conference Registration 2023 Registration InfoRegistration Fee (Postmarked on or before September 1, 2023)Name(Required) First Last Job Title Home Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone(Required)Home Email(Required) I'm registering as a facility Yes Facility Name(Required) Facility Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Work Phone(Required)Work Email(Required) First IAPA Conference?(Required)Please Select an OptionYesNoWould you like an email confirmation?(Required)Please Select an OptionYesNoWhere would you like to receive your email confirmation?(Required) Enter Email Confirm Email Are you an IAPA Member?(Required)Current IAPA members save on conference feesPlease Select an OptionYesNoJoin TodayTake advantage of the Member Rate by Joining Today. By checking the box below, you will be able to take advantage of IAPA member pricing for the conference as well as a discounted membership rate.I would like to sign up for an IAPA membership Yes IAPA Member Conference FeesIAPA Membership Registration Fees(Required)Please select the appropriate choicePlease Select an OptionIndividual Membership Fee - New - $35Facility Membership Fee - New - $50Retired Charter Member - $0Retiree - $17.50IAPA Membership Renewal FeesRenew your membership along with your registrationPlease Select an OptionIndividual Membership Fee - Renewal - $35Facility Membership Fee - Renewal - $50Retired Charter Member - $0Retiree - $17.50Lapsed Membership FeeIf you are renewing a membership that has lapsed, you must check the box below I am renewing a lapsed membership IAPA Member Conference Fees(Required)Please select the appropriate choicePlease Select an OptionAll 3 Days (Includes lunches) - $365Wednesday Only Registration (8 CE’s - Includes lunch) - $150Thursday-Only Registration (6 CE’s - Includes lunch) - $140Friday-Only Registration (4 CE’s - Includes lunch) - $120Wednesday and Thursday (Includes lunches) - $250Wednesday and Friday (Includes lunches) - $230Thursday and Friday Registration (10 CE’s Includes lunches) - $220Administrators Attending All 3 Days with a staff member (Includes Lunches) - $250Administrators Attending Thursday and Friday with a staff member (Includes Lunches) - $100Retired Board Member Rate Thursday and Friday (Includes Lunches) - $100Non-Member Conference FeesNon-Member Conference Fees(Required)Please select the appropriate choicePlease Select an OptionAll 3 Days (Includes lunches) - $465Wednesday Only Registration (8 CE’s - Includes lunch) - $200Thursday-Only Registration (6 CE’s - Includes lunch) - $190Friday-Only Registration (4 CE’s - Includes lunch) - $170Wednesday and Thursday (Includes lunches) - $300Wednesday and Friday (Includes lunches) - $280Thursday and Friday Registration (10 CE’s Includes lunches) - $270Administrators Attending All 3 Days with a staff member (Includes Lunches) - $350Administrators Attending Thursday and Friday with a staff member (Includes Lunches) - $150Retired Board Member Rate Thursday and Friday (Includes Lunches) - $150Meal SelectionThe following meals are included in the conference registration price, but you must sign up to be included in meal totals.Wednesday Meals(Required)Please select all that apply Wednesday Lunch Wednesday Vendors' Social Select AllThursday Meals(Required)Please select all that apply Thursday Lunch Thursday’s Campfire Gathering and Quarter Auction Select AllFriday Meal(Required)Please select all that apply Friday Lunch Select AllPlease indicate special dietary requirementsGuest Meal TicketsGuests not registered for the conference must have a ticket for all meals. Please indicate # of tickets needed for your guests.Wednesday Lunch Price: $24.00 Quantity: Thursday Lunch Price: $26.00 Quantity: Friday Lunch Price: $26.00 Quantity: Wed. Vendor Social Price: $0.00 Quantity: Thur. Campfire Price: $0.00 Quantity: Breakout SessionsBreakouts sessions are listed below. For descriptions of the specific Breakouts, please refer to the ITINERARY section of the brochure. Please indicate your 1st choice for each time period. Every attempt will be made to give each participant their first choice. However, decisions will be made on a first come basis, so register early. If you are registering for a single day, you will have admittance to the Breakouts listed for that day only.Wednesday SessionWednesday, October 4, 2023 - 8:00AM - 4:30PM(Required)Intensive – Rachelle Blough – Offering Certified Dementia Practitioner certificationPlease Select an OptionI will attendI will not attendThursday SessionsThursday, October 5, 2023 - 9:00AM - 10:00AM(Required)Keynote Speaker, Lisa Olson, “The Rhythm of Life”Please Select an OptionI will attendI will not attendThursday October 5, 2023 - 10:45AM - 12:15PM(Required)Please Select an OptionA – Jackie Shaffer & Becky Gordon: “Bring History Alive” (Intensive I)B – Rachel Keistler: - “Let’s Talk About S’More Tech Tips”C - Misty Duncan & Alex Withers: “Blind and Low Vision Resources and Activity Options”Thursday October 5, 2023 - 1:45PM - 3:15PM(Required)Please Select an OptionD - Jackie Shaffer & Becky Gordon: “Bring History Alive” (Intensive II)E - Jonathan Harwood: “Don’t Get BURNED Out. Find a Good Activity To Do!”F - Victoria Stoye: “Campfire Songs"Thursday October 5, 2023 - 3:30PM - 5:00PM(Required)Please Select an OptionG - Jackie Shaffer & Becky Gordon: “Bring History Alive” (Intensive III)H - Traci Pareti: “Montessori Principle/Programming Ideas”I - Jim Vanden Bosch: “The Fire Inside Us All”Friday SessionsFriday October 6, 2023 - 9:00AM - 10:30AM(Required)Please Select an OptionJ - Joe Agnello: “I Love It Here – The Practice of Appreciative Inquiry”K - Lisa Olson: “Active Listening (DD/MI)”L - Kathy Clark: “Fire Up Your Creative Juices – Be Memorable for Less $”Friday October 6, 2023 - 10:45AM - 12:15PM(Required)Please Select an OptionM - Joe Agnello: “Men Are From Mars – Understand Their Way of Life”N – Kim Hayes: “Keep The Fire Burning For Your Clients Through Safe Movement”O - Deb Greiner & Pam Goff: “Camp Crafts That Go Beyond the Campground”Friday October 6, 2023 - 1:30PM - 2:30PM(Required)P - Deb Greiner: “Camp Chat – Share Your Best Activity”Please Select an OptionI will attendI will not attendFriday October 6, 2023 - 2:30PM - 3:30PM(Required)Raffle, Silent Auction, Closing, Hand in EvaluationsPlease Select an OptionI will attendI will not attendMembership RegistrationIAPA Committee InterestI am interested in participating in or learning more about the following: Membership Finance Awards Conference Newsletter Public Relations By-Laws Government Relations Ways and Means Education Nominating Marketing Archives Select AllInformation InterestPlease send me information regarding: IAPA Certification Becoming a Board Member Quarterly Board Meetings Annual October Conference Submitting Newsletter Articles Select AllDo you have special interest? Adult Day Services Retirement Senior Centers Mental Health Alzheimer's Consultants Supportive Living Other Select AllType of Facility / Agency(Required)Nursing HomeRetirementAdult Day ServicesAssisted LivingSenior CenterMental HealthHospitalPayment InformationRefund Policy: Cancellations received on or before 9/5/23 will receive full refund. Cancellations received 9/10/23– 9/14/23 will receive a refund less a $50 processing fee. Cancellations received on or after 09/15/23 will not be refunded.Total Billing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit CardCard Details Cardholder Name
