Educational Conference Registration Form

To register for the Education Conference, please complete the form below.

First Name:
Last Name:
Address:
Address (cont):
City:
State:
Zip:
Phone: (with Area Code)
Email:
Profession:
Employer:
Ticket Type:
	I wish to make a donation to PADS, Parent Advocates Down Syndrome OR for Teen or Adult Self Advocate Session for amount specified
Donation Amount:	$
Honoree's Name

Total:	$
Credit card type:
Credit card number:
Credit Card Expiration Date:
Exact name on card:

Educational Conference Participants by clicking on "I Agree," you agree, warrant and covenant as follows: Waiver: In consideration of me and/or my minor child being permitted to participate in the Educator's Conference, I hereby-for myself, my heirs and personal representatives assume any and all risks which might be associated with the event. I further waive, release, discharge and covenant not to sue Parent Advocates Down Syndrome and Shelby County Instructional Services Center, their sponsors, organizers, volunteers or other representatives or their successors and assigns, for any and all injuries or damages of any kind whatsoever suffered by myself and/or my minor child as a result of taking part in the events and any related activities. I also authorize the use by Parent Advocates Down Syndrome of any photo, film or videotape taken of me or my minor child at the event for any purpose.

Pages