NASDDDS 2012 Mid-Year Conference
June 7 & 8
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Directors Forum
June 6
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Embassy Suites Sacramento - Riverfront Promenade
Sacramento, California
~ REGISTRATION FORM ~
Please fill in ALL of the registration blanks.
This input will be used for your badge & the 'Attendee List' to be distributed at the meeting.

First Name

Last Name

FULL NAME FOR BADGE
(your name as it will appear on your badge, etc...)

Job Title

Phone
(numbers only, no dashes, etc.)

Fax
(numbers only, no dashes, etc.)

Email Address

Agency/Organization

Division

Mailing Address

City

State/Province

Zip/Postal Code

Country
DIETARY RESTRICTIONS:
Vegetarian Vegan No red meat Kosher No pork Other (Specify)
REGISTRATION FEES MEMBER Attending Conference - $395 Alumni Member Attending Conference - $395

NON-MEMBER Attending Conference - $495

Attending Directors Forum ONLY- $150

GROUP RATE - $295 per person (for groups of THREE individuals or more from the same organization or agency registering at the same time)Self-Advocate, Family Member, or Student -attending conference
Self-Advocate - $200
Family Member - $200
Student - $200
CHECK THE APPROPRIATE BOX(ES):
I am planning to attend the Directors Forum on
Wednesday, June 6 (NASDDDS Members Only).

I am planning to attend the reception on
Thursday, June 7, 5:30 PM - 7:00 PM (open to all attendees).
SPECIAL ACCOMMODATIONS or Other Requests: If you require a special accommodation to facilitate participation in the meeting or have additional billing or other comments, please indicate below:
Wheelchair Access
Sign Language Interpreter
Braille Documents
Other, please describe below
(use this space for any requirements pertaining to your meeting/registration needs):
The 2012 Mid-Year Conference will be held at the Embassy Suites Sacramento - Riverfront Promenade, located on the Sacramento River, directly across from Old Sacramento offering spectacular views of the river and the capitol. Situated within walking distance to charming restaurants on the Riverside Promenade, shops, museums, and many other local attractions. The rate is $185 per night for a standard room plus applicable taxes. There are three ways to make reservations:
1. Go to www.sacramento.embassysuites.com and make a reservation using the group/convention code: NSD.
2. Call 1-800-Embassy and ask for the NASDDDS discounted group rate.
3. Private Online Webpage. Please keep in mind that all reservations must be in by May 14.
An invoice for the registration fee will be emailed to the address provided on this form. Credit cards or checks are accepted as payment.
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National Association of State Directors of Developmental Disabilities Services
113 Oronoco Street, Alexandria, VA 22314; Tel: (703) 683-4202