Flagstaff Roundup SCI Summer Conference

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SCI Summer Conference is on June 5th & 6th in Flagstaff AZ at the Family Resource Center Flagstaff Unified School District. If you are planning on attending please fill out the registration form below. If you have any questions please feel free to contact Tiffany Wilkinson at the Arizona Spinal Cord Injury Association, tiffany@azspinal.org, or by phone 602-507-4209 or Dr. Susan Wolf, Empowerment Research, LLC at drsuewolf@me.com or 480-354-9000. Thank you.

Last Name *

First Name *

Home Address *

Zipcode *

Home/Cell Phone Number *

Alternate Phone Number

Email Address *

If you have any food allergies please list them below.

On Thursday evening, the 5th, we are hosting a wheelchair skills clinic from 4:30pm-8pm. Please indicate below if you plan on attending. *

Yes

Other:

For Friday's all day conference in the afternoon we have 3 breakout sessions. Please choose one session from the options below so we can plan accordingly. *

2nd Session Wheelchair Skills Clinic

Craniosacral Therapy Session

Adaptive Recreation Program Development for Northern AZ

Required

If you only plan to come for lunch and the afternoon workshops of the conference please indicate that below so we have an accurate count for lunch.

Yes

Other:

Clear selection

If you are only planning on coming to the Adaptive Recreation Planning meeting please indicate that here.

Please choose a demographic category from the list below.

Consumer

Family Member

Professional

Other:

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