Pacific Rim International Disability and Diversity Week May 18-22, 2015 Registration Form (for all events) Please note* registration to both conferences are at a significant discount (page 5) Hawai i Convention Center, Honolulu, Hawai i PLEASE PRINT This will be the name that appears on your nametag First Name: Last Name: Organization: Street Address 1: Street Address 2: City: State/Province: Zip/Postal Code: Country: Phone: Fax: Email Address: Accessibility Requests Deadline for requests is April 20, 2015. Any requests after this date will be fulfilled if services are available. Assistive Listening Device: Braille Materials: Human Guide for Sight: Large Print Materials: Note Taker: Sign Language Interpreter Services: ASL: Vegetarian Meal: Vegan Meal: ** For IASSIDD Academy Mid-Week Workshops, see separate registration, located under Disability and Diversity Week page. 1 of 6
PACIFIC RIM INTERNATIONAL CONFERENCE ON DISABILITY AND DIVERSITY May 18-19, 2015 PLEASE CHECK for Pac Rim Only REGISTRATION: **Conference fee includes 2 days of sessions, continental breakfast, lunch, and poster reception. Registrations received after April 30, 2015 will be charged the On-Site rate.** Standard Registration rates postmarked February 17, 2015 April 30, 2015 $350 Regular $300 Kama aina (Hawai i Residents; Photo I.D. required) $240 Student, both days (full-time only - please fax semester schedule) $215 1 Day registration On-Site Registration rates after April 30, 2015 $375 All Participants, both days $240 1 Day registration Note: Registration for Personal Assistants is essential. Full registration cost is waived. There is a small food-related fee of $115 per person for each conference. $115 Personal Assistant Please choose which program book format you would like to receive: We are offering alternative program book formats in an attempt to go green! ebook - Complimentary (will receive link 6-14 days in advance) * a limited amount of the printed program will be available to purchase on site for $20.00 each if you change your mind. PDF - Complimentary (will receive 6-14 days in advance) Printed @ $15.00 each 2 of 6
! Pac Rim Pre- and Post- Conference Events Post-Conference Events If you are interested in attending one or more of these events, please check the appropriate box(es). If you are not registered for the conference but want to attend one of these events, please check the box and pay only the amount for the event(s) attending. Conference Week Dinner Reception: Honolulu Zoo Wednesday, May 20 th, 2015, 4:00 P.M. 8:30 P.M. Registration Cost: $80.00 ICF Workshop Hawaii Convention Center, Wednesday, May 20 th, 2015, 8:30 A.M. 12:30 P.M. Registration Cost: $65.00 Inclusive Education Institute (includes lunch) Hawaii Convention Center, Wednesday, May 20 th, 2015, 8:00 A.M. 4:30 P.M. Registration Cost: $140.00 From Findings to Action: Evaluation Reporting That Gets Attention (with Kylie Hutchinson) Wednesday, May 20 th, 2015, 12:45 pm 5:15 P.M. Registration Cost: $65.00 ($75.00 on-site)! Publication! Review of Disability Studies: An International Journal one (1) year subscription Special conference attendee rate: $40.00 (Please check back for more institutes that may not be listed.) 3 of 6
May 21-22, 2015 PLEASE CHECK for IASSIDD Only REGISTRATION: * To register as an IASSIDD member you MUST be an active 2015 IASSIDD member before April 30, 2015. Standard Registration rates postmarked February 17, 2015 April 30, 2015 $350 Regular $300 IASSIDD Member * or Kama aina (Hawai i Residents; Photo I.D. required) $240 Student (full-time only - please fax semester schedule) $215 1 Day registration On-Site Registration rates after April 30, 2015 $375 All Participants, both days $240 1 Day registration Conference Week Dinner Reception: Honolulu Zoo Wednesday, May 20 th, 2015, 4:00 P.M. 8:30 P.M. (Registration Cost: $80.00) Note: Registration for Personal Assistants is essential. Full registration cost is waived. There is a small food-related fee of $115 per person for each conference. Please contact (808) 956-8816 for more information. $115 Personal Assistant Please choose which program book format you would like to receive: We are offering alternative program book formats in an attempt to go green! ebook - Complimentary (will receive 6-14 days in advance) * a limited amount of the printed program will be available to purchase on site for $20.00 if you change your mind. PDF - Complimentary (will receive 6-14 days in advance) Printed @ $15.00 each 4 of 6
Save$$ Save $$ Save $$ Save $$ BONUS PRICE!! Attend BOTH Conferences? Take advantage of this special occasion by attending both the Pacific Rim and IASSIDD conferences at a reduced rate! PACIFIC RIM INTERNATIONAL CONFERENCE ON DISABILITY AND DIVERSITY AND International Association for the Scientific Study of Intellectual and Developmental Disabilities Americas Regional Congress May 18-22, 2015 PLEASE CHECK to attend BOTH Conferences REGISTRATION: *To register as an IASSIDD member you MUST be an active 2015 IASSIDD member before April 30, 2015. Standard Registration rates postmarked February 16, 2015 April 30, 2015 $660 Regular $540 IASSIDD Member* or Kama aina (Hawai i Residents; Photo I.D. required) $475 Student (full-time only - please fax semester schedule) On-Site Registration rates postmarked after April 30, 2015 $710 Regular, IASSIDD Member or Kama aina (Hawai i Residents; Photo I.D. required) $650 Student (full-time only - please fax semester schedule) Conference Week Dinner Reception: Honolulu Zoo Wednesday, May 20 th, 2015, 4:00 P.M. 8:30 P.M. (Registration Cost: $80.00) Note: Registration for Personal Assistants is essential. Full registration cost is waived. There is a small food-related fee of $115 per person for each conference. Please contact (808) 956-8816 for more information. $230 Personal Assistant Please choose which program book format you would like to receive: We are offering alternative program book formats in an attempt to go green! PACRIM & IASSIDD Program books: ebook - Complimentary (will receive 6-14 days in advance) * a limited amount of the printed programs will be available to purchase on-site for $20.00 each if you change your mind. PDF - Complimentary (will receive 6-14 days in advance) Printed @ $15.00 each 5 of 6
Method of Payment Checks, Money Orders and Purchase Orders are to be made payable to: RCUH #1324. Pac Rim Federal Tax ID # 99-0115254. Hawai i Department of Education Code 119-183. Conference(s) Attending: Pacific Rim (Both Days) Monday, May 18 Tuesday, May 19 Pacrim Event(s) (May 20) IASSIDD Academy Workshop(s) (May 20) IASSIDD (Both Days) Thursday, May 21 Friday, May 22 Pacific Rim and IASSIDD* Conference Week Dinner Reception Total Amount: $ (including Pre- and Post-Conference Events) Check Money Order: Credit Card (Fill out next section) Purchase Order #: Credit Card Information If emailing form, please DO NOT enter your credit card number below. We will call you to complete the registration process. Alternatively, you may fax this form with credit card info to our secure line 808-956-4437. Check one: MasterCard Visa Last 4 Digits Exp. Date 3 or 4 Digit Security Code (We will call you for full number) (Listed on the back of card) Name Phone Number (As it appears on the card) Billing Address 1 Billing Address 2 City State/Province Postal Code Country E-Mail Address Mail, Fax or E-mail Contact the Registration Desk with any concerns. Call 1-(808) 956-8816. Mail to: Pac Rim Conference, Center on Disability Studies, 1776 University Avenue, UA 4-6,Honolulu, Hawai i 96822. Fax to: 1-(808) 956-4437, or email prreg@hawaii.edu. Refunds/Cancellation Policy All cancellations must be made in writing, mailed and postmarked no later than Friday, February 13, 2015. No refunds will be issued after this date. A processing fee of $40.00 (U.S. dollars) will be assessed for all cancellations. All refund checks will be mailed approximately six to ten weeks after the conclusion of the conference. Mahalo! 6 of 6