Access to Education 2019 Conference Registration
Note of agreement before you begin:

Photos, Audio and Video for the day of the Conference:

PATINS staff or designees may be taking photographs at this event and/or video/audio recording and interviewing speakers, attendees, and exhibitors to use in our marketing materials or on the Internet in conjunction with the State Conference. By registering for the State Conference, you have been notified of our intent and by attending the State Conference you waive any rights and any claims regarding the taking or publishing of such photos, audio and video.

PAYMENT, INVOICING & REFUNDS:
- A PO, Check or Code is required to reserve your registration slot.
- You will be invoiced for registration fees directly after you successfully register. You may transfer your registration if you are unable to attend.
- No Refunds will be issued.
- For your convenience, you may print our W-9 by using the following link: https://goo.gl/inDxf6
- Checks can be made payable to CIESC or PATINS
- Registration deadline is November 13, 2019.

REGISTRATION Email:
- If you will be registering more than one person from your school district and intend for them to each receive their own communication from us as the conference approaches, please provide us with a unique email address for each person.

Access to Education 2019 General Information
Date: Wednesday, November 20 and Thursday, November 21, 2019

Time: 9:00 a.m. - 3:30 p.m. EST each day

Location: Historic Crowne Plaza Union Station
Downtown Indy - 123 W. Louisiana St. Indianapolis, IN 46225

Registration Fee: $100/1 day $200/2 days

Registration Deadline: November 13, 2019

A Certificate of Participation, with eligible Professional Growth Points (PGPs) and Contact Hours, will be issued upon completion of a short conference evaluation.

First Name: *
Your answer
Last Name: *
Your answer
Job Title: *
Your answer
Organization: *
Your answer
School Corporation in which you are employed or N/A: *
Your answer
Daytime Phone Number: *
Your answer
Email Address: *
*Your confirmation with invoice will be emailed to this address.
Your answer
On day 1, November 20, I will be: *
On day 2, November 21, I will be: *
Building Administrator's Name, Special Education Director's Name or N/A: *
Your answer
Building Administrator's eMail, Special Education Director's eMail or N/A: *
Your answer
Please list any disability-related accommodation needed for the day(s) or N/A: *
Your answer
Please list any dietary accommodation needed for the day(s) or N/A: *
Your answer
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