2010 Conference Application

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Thank you for registering for FRUA's 7th annual educational conference. We look forward to seeing you in Philadelphia this Fall!

Name (Attendee A) First Name Last Name

Additional Name if registering as a couple (Attendee B) First Name Last Name

Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address

REGISTER FOR (main program):

Friday Only
Saturday Only
Both Days

WORKSHOP SELECTIONS

Please refer to the conference program for full workshop descriptions. Choose ONE workshop only for each time segment. Choice 2 will be used if Choice 1 workshop is full.

SATURDAY Oct. 16 - 10:30 AM - 12:00 PM

A. Hip Hop Health - Chris Wells/Kurtis Johnson

Attendee A-Choice 1
Attendee A-Choice 2
Attendee B-Choice 1
Attendee B-Choice 2

B. Sensory Integration & Trauma - Amy Lynch/Stephanie Drabble

Attendee A-Choice 1
Attendee A-Choice 2
Attendee B-Choice 1
Attendee B-Choice 2

C. For Dads Only - Jerry Petroff

Attendee A-Choice 1
Attendee A-Choice 2
Attendee B-Choice 1
Attendee B-Choice 2

D. Dental Growth & Development - Victoria Roeder

Attendee A-Choice 1
Attendee A-Choice 2
Attendee B-Choice 1
Attendee B-Choice 2

SATURDAY, Oct. 16 - 1:15 PM - 2:45 PM

A. Developmental & Behavioral Challenges - LIsa Albers Prock

Attendee A-Choice 1
Attendee A-Choice 2
Attendee B-Choice 1
Attendee B-Choice 2

B. Children's Development - Wendy Schmidt

Attendee A-Choice 1
Attendee A-Choice 2
Attendee B-Choice 1
Attendee B-Choice 2

C. Student Success - Megan Procaccini/Joy Ottens

Attendee A-Choice 1
Attendee A-Choice 2
Attendee B-Choice 1
Attendee B-Choice 2

D. FASD - Alicia Bashian

Attendee A-Choice 1
Attendee A-Choice 2
Attendee B-Choice 1
Attendee B-Choice 2

TEEN PROGRAM REGISTRATION

Only teens with paid parent registration may participate. Ages 13-18.

Register for:

Teen Program

Name of Teen First Name Last Name

Please include names of additional teens in the comment section below.

FEES

Parent/Single

One Day=$150
Both Days=$250

Parent/Couple

One Day=$230
Both Days=$425

Professional

One Day=$190
Both Days=$350

Teen Program

$50 per teen

DISCOUNTS AVAILABLE

FRUA Member-1 day=$35
FRUA Member-2 days=$50
Early Registration=$25
Full time student=$25

Early registration deadline is Sept. 10, 2010; Full time student discount for main progam only.

SHUTTLE SERVICE

Friday Shuttle
Saturday Shuttle

Please check appropriate box if you will be requiring shuttle service to/from hotel & conference center. There is no charge for this service.

PAYMENT OPTIONS:

Pay by Check
PayPal

Payment by check: Submit online form, mail check to: Lori Zimmer, 598 Garrison Ct., Delafield, WI 53018

Registration will be confirmed upon receipt of payment.

Payment by PayPal: After submitting online registration, you will be sent a PayPall invoice via email. There is an additional $6 fee for using PayPal.

Registration will be confirmed upon receipt of payment.

Comments, questions or names of additional teens that will be attending.

View Conference sponsors

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