Online Fax or Mail Educator Registration Form for the ADDA-SR Conference

Meeting the Challenge

Fill out the information below completely one form per attendee. Then click on the register button and you will be registered for the conference on line or you can print it in order to fax or mail. 


Registration information

 

 

After completing all necessary forms, you may submit the forms:

  1. Online after completing
  2. Print this forms and fax them to ADDA-SR office at 281-894-6883
  3. Print this form and mail them form(s) to:
    ADDA-SR
    12345 Jones Rd., #287-7
    Houston, TX 77070.

Discounts for registration cost per School or School District  if received by January 31, 2008.  After January 31, add $10.00 per attendee.

Price per attendee without membership for attending one day.
2 attendees 3-5 attendees More than 5 attendees
$105 $95 Contact ADDA-SR web host or office

Price per attendee without membership for attending both days.
2 attendees 3-5 attendees More than 5 attendees
$185 $170 Contact ADDA-SR web host or office

 

Price per attendee with one paid $40 membership attending one day.
2 attendees 3-5 attendees 5  attendees
$70  $60  Contact ADDA-SR web host or office

Price per attendee with one paid $40 membership attending both days.
2 attendees 3-5 attendees 5  attendees
$135 $120 Contact ADDA-SR web host or office

Add $10.00  per attendee for registrations received after January 18.

Attendees include staff members, parents or others that a school or district might choose to send. 

Please E-mail a rate for more than 5 attendees . 

Back to Conference information page.  

The following must be complete by School or School district and attached to check or PO with one completed staff registration form per attendee. 

Name of School
Name of ISD   (Ex. Mesquite )
ISD

Total cost per school or school district:

 

Number attending

Cost per Person

Total
Registration Fee

$

 $
Membership to ADDA-SR Already member. $40 $
Dinner

$35

 $
 

Total due

 $

I am joining ADDA-SR as a:

 Individual/Family or Educator  $40.00
Parent     Adult with ADHD    Educator      School Counselor 

 Person who is becoming a member please complete this membership form as well as an attendee form at the bottom of the page.
Name of member:  
Occupation:  
Street Address:  
City:  
State:  
Zip Code:  
Telephone:  
E-mail:  
Employed By:  
Referred By:  

 
Payment Method:
Master Card Visa
Discover

American Express
Check
PO number

Print Name on Card:

 
Street Address for Card:  
Zip Code for Card:  
Account Number:  
Expiration Date    
*Electronic Signature:  

* Entering your name into the blank is the same as a hand written signature.

  

 

Each attendee must compete a registration form to accompany the payment

Last Name:   First Name:  
Street Address:
City: 
County: 
 State:
Zip Code:
Telephone:
E-mail:
 School Name:
School District:
 School Telephone:
 Position:

Mark all that apply
Parent Adult with ADHD Educator Healthcare Professional

How did you hear about the conference?

  Yes, I need an CPE certificate.

Please have each staff member attending  fill out one of these forms and attach it to PO, check or charge information. 

Early registration must be received in office by Thursday, January 31, 2008.

All registrations must be received in office by Friday, February 8, 2007.
 

   Required Session Selections

Select session number from schedule. Your registration is not complete without session selection as there is  limited seating. We will do our best to accommodate everyone’s choice.

Please note:  You must attend noted ethics sessions to receive ethics credit.

 
So many choices.

Which one do I pick?

Friday 

Pre-conference 8:00

 

YES

NO
11:00
1 2 3 4 5
1:45
1 2 3 4 5
3:30
1 2 3 4 5

Saturday
Pre-conference 8:00

YES

NO
11:00
1 2 3 4 5
1:45
1 2 3 4 5
3:30
1 2 3 4 5

 

Each attendee must compete a registration form to accompany the payment

Last Name:   First Name:  
Street Address:
City: 
County: 
 State:
Zip Code:
Telephone:
E-mail:
 School Name:
School District:
 School Telephone:
 Position:

Mark all that apply
Parent Adult with ADHD Educator Healthcare Professional

How did you hear about the conference?

  Yes, I need an CPE certificate.

Please have each staff member attending  fill out one of these forms and attach it to PO, check or charge information. 

Early registration must be received in office by Thursday, January 31, 2008.

All registrations must be received in office by Friday, February 8, 2007.
 

   Required Session Selections
Select session number from schedule. Your registration is not complete without session selection as there is  limited seating. We will do our best to accommodate everyone’s choice.

Please note:  You must attend noted ethics sessions to receive ethics credit.

 
So many choices.

Which one do I pick?

Friday 

Pre-conference 8:00

 

YES

NO
11:00
1 2 3 4 5
1:45
1 2 3 4 5
3:30
1 2 3 4 5

Saturday
Pre-conference 8:00

YES

NO
11:00
1 2 3 4 5
1:45
1 2 3 4 5
3:30
1 2 3 4 5

 

Each attendee must compete a registration form to accompany the payment

Last Name:   First Name:  
Street Address:
City: 
County: 
 State:
Zip Code:
Telephone:
E-mail:
 School Name:
School District:
 School Telephone:
 Position:

Mark all that apply
Parent Adult with ADHD Educator Healthcare Professional

How did you hear about the conference?

  Yes, I need an CPE certificate.

Please have each staff member attending  fill out one of these forms and attach it to PO, check or charge information. 

Early registration must be received in office by Thursday, January 31, 2008.

All registrations must be received in office by Friday, February 8, 2007.
 

   Required Session Selections
Select session number from schedule. Your registration is not complete without session selection as there is  limited seating. We will do our best to accommodate everyone’s choice.

Please note:  You must attend noted ethics sessions to receive ethics credit.

 
So many choices.

Which one do I pick?

Friday 

Pre-conference 8:00

 

YES

NO
11:00
1 2 3 4 5
1:45
1 2 3 4 5
3:30
1 2 3 4 5

Saturday
Pre-conference 8:00

YES

NO
11:00
1 2 3 4 5
1:45
1 2 3 4 5
3:30
1 2 3 4 5

 

Each attendee must compete a registration form to accompany the payment

Last Name:   First Name:  
Street Address:
City: 
County: 
 State:
Zip Code:
Telephone:
E-mail:
 School Name:
School District:
 School Telephone:
 Position:

Mark all that apply
Parent Adult with ADHD Educator Healthcare Professional

How did you hear about the conference?

  Yes, I need an CPE certificate.

Please have each staff member attending  fill out one of these forms and attach it to PO, check or charge information. 

Early registration must be received in office by Thursday, January 31, 2008.

All registrations must be received in office by Friday, February 8, 2007.
 

   Required Session Selections
Select session number from schedule. Your registration is not complete without session selection as there is  limited seating. We will do our best to accommodate everyone’s choice.

Please note:  You must attend noted ethics sessions to receive ethics credit.

 
So many choices.

Which one do I pick?

Friday 

Pre-conference 8:00

 

YES

NO
11:00
1 2 3 4 5
1:45
1 2 3 4 5
3:30
1 2 3 4 5

Saturday
Pre-conference 8:00

YES

NO
11:00
1 2 3 4 5
1:45
1 2 3 4 5
3:30
1 2 3 4 5

 

Form Submission

 

Early Registration must be received in the office by Thursday, January 31, 2008. 

All registrations must be received in office by Friday, February 8, 2008.

Walk-ins welcome.

Return to: 
 ADDA-SR
12345 Jones Rd. # 287-7
Houston, TX 77070
Phone   281-897-0982
FAX   281-894-6883

Thank you for visiting!

This page designed by Opal Harris.
Copyright © 2001 [ADDA-SR]. All rights reserved.
Revised: January 21, 2008.