2008 State Leaders Summit on Deaf Education Registration


		State Leaders Summit: Making a Commitment to Improve Results for Children and Youth who are Deaf or Hard of Hearing. April 29, 30, & May 1, 2009 Hilton Santa Fe Historic Plaza Santa Fe, New Mexico 1-800-336-3676 To register for the 2009 Summit, please read all information, including the 2009 Program Announcement and Information, and then complete the registration form for each team member in its entirety. When complete, click "Register Now" at the bottom of the page. Registration is by team. If you have questions about this requirement, you can contact Cheryl Johnson (cheryl@colorado.edu) or Carol Massanari (ckmassanari@earthlink.net). State Leadership Team representation should minimally include the following three individuals: a parent leader, a representative of the state department of education (deaf program consultant or special education director), and a leader representing state special schools and/or programs for the deaf. Additional team members to consider include representatives from higher education, early childhood deaf education, local programs, or others who have a vested interest and potential influence in improving educational outcomes for children and youth who are deaf or hard of hearing. The person completing the registration information automatically will be sent an email confirming receipt of the electronic registration. Soon after, an email confirmation will be sent to each team member as well. About a month prior to the Summit, each registered participant will be sent a reminder confirmation with a final agenda. If you register before April 15, 2009, the registration fee per participant is $225. If you register after April 15, 2009, the registration fee per participant is $250. Each team member will be invoiced separately for the registration fee (except the parent leader whose fee is waived). If any member of your team will be paying with a purchase order, please mail it or fax the PO to: Mountain Plains Regional Resource Center Attn: Kath Richman 1780 North Research Parkway, Suite 112 North Logan, UT 84341 Fax: 435-753-9750 Further information, including a draft agenda and information about Parent Participation Stipends, can be found at State Leaders Summit Information Website. Parent Participation Stipend applications can be downloaded from http://www.ndepnow.org Note: Please review the 2009 Program Announcement and Information on the State Leaders Summit Information Website regarding State Team Requirements. If you have less than the three required State Team members, please check with Cheryl Johnson at cheryl@colorado.edu to verify that you fit the exception before proceeding. If you represent a national organization that is not part of a state team and think you should be part of this summit, please check with Cheryl Johnson at cheryl@colorado.edu to determine if you fit the individual exception before proceeding. For those registering under one of the above exceptions, please provide the date of verification and the verification code: Date________________ Code__________________. If you are registering under an exception with fewer three team members, you will have to register directly with Kath Richman. To do so, you should contact her 435-752-0238 x. 26.

For each team member registered, all fields are required. All fields for a team member you are registering must be filled in, even if the information duplicates another team member (e.g., billing information). If your team is greater than eight people, you will need to complete multiple registration pages.
State (or organization/agency if individual): Name of person registering the team: Phone Number of person registering the team: Number of Team Members: (Note: The registration form allows for up to eight team members. If you have more than eight, contact Kath Richman at Kathleen.Richman@usu.edu or 435.752.0238, ext. 26 to let her know you will need more spaces.)
Team Member Number One
Member Information Member Role: Member Name (to appear on your name tag): Organization: Email Address: Phone Number: Ext. Special Accommodations: If you need an interpreter, assistive technology, special seating, vegetarian meals or other accommodations or assistance to attend this conference, please delete this text and enter it here. Thank you.	Billing Information Contact: Billing Street Address: Billing City, State, Zip: Billing Email Address: Billing Phone: Ext.
Team Member Number Two
Member Information Member Role: Member Name (to appear on your name tag): Organization: Email Address: Phone Number: Ext. Special Accommodations: If you need an interpreter, assistive technology, special seating, vegetarian meals or other accommodations or assistance to attend this conference, please delete this text and enter it here. Thank you.	Billing Information Contact: Billing Street Address: Billing City, State, Zip: Billing Email Address: Billing Phone: Ext.
Team Member Number Three
Member Information Member Role: Member Name (to appear on your name tag): Organization: Email Address: Phone Number: Ext. Special Accommodations: If you need an interpreter, assistive technology, special seating, vegetarian meals or other accommodations or assistance to attend this conference, please delete this text and enter it here. Thank you.	Billing Information Contact: Billing Street Address: Billing City, State, Zip: Billing Email Address: Billing Phone: Ext.
Team Member Number Four
Member Information Member Role: Member Name (to appear on your name tag): Organization: Email Address: Phone Number: Ext. Special Accommodations: If you need an interpreter, assistive technology, special seating, vegetarian meals or other accommodations or assistance to attend this conference, please delete this text and enter it here. Thank you.	Billing Information Contact: Billing Street Address: Billing City, State, Zip: Billing Email Address: Billing Phone: Ext.
Team Member Number Five
Member Information Member Role: Member Name (to appear on your name tag): Organization: Email Address: Phone Number: Ext. Special Accommodations: If you need an interpreter, assistive technology, special seating, vegetarian meals or other accommodations or assistance to attend this conference, please delete this text and enter it here. Thank you.	Billing Information Contact: Billing Street Address: Billing City, State, Zip: Billing Email Address: Billing Phone: Ext.
Team Member Number Six
Member Information Member Role: Member Name (to appear on your name tag): Organization: Email Address: Phone Number: Ext. Special Accommodations: If you need an interpreter, assistive technology, special seating, vegetarian meals or other accommodations or assistance to attend this conference, please delete this text and enter it here. Thank you.	Billing Information Contact: Billing Street Address: Billing City, State, Zip: Billing Email Address: Billing Phone: Ext.
Team Member Number Seven
Member Information Member Role: Member Name (to appear on your name tag): Organization: Email Address: Phone Number: Ext. Special Accommodations: If you need an interpreter, assistive technology, special seating, vegetarian meals or other accommodations or assistance to attend this conference, please delete this text and enter it here. Thank you.	Billing Information Contact: Billing Street Address: Billing City, State, Zip: Billing Email Address: Billing Phone: Ext.
Team Member Number Eight
Member Information Member Role: Member Name (to appear on your name tag): Organization: Email Address: Phone Number: Ext. Special Accommodations: If you need an interpreter, assistive technology, special seating, vegetarian meals or other accommodations or assistance to attend this conference, please delete this text and enter it here. Thank you.	Billing Information Contact: Billing Street Address: Billing City, State, Zip: Billing Email Address: Billing Phone: Ext.
If your team has more than eight members, please contact Kath Richman at 435-752-0238 x. 26 or kathleen.richman@usu.edu.