Project ACTION Conference Registration Form
Content
Project ACTION! presents: “The Power of Self-Advocacy” Conference
co-sponsored by the National School of Social Service, Center for Community and Social Justice Saturday, June 12, 2010 from 8:00am – 5:00pm
Catholic University of America’s Pryzbyla Center 620 Michigan Avenue, NE, WDC 20064 REGISTRATION FORM Registrant Information (Conference is intended for self-advocates) : First Name __________________________ Last Name _____________________________ Address _____________________________________________________________________ City _________________________________ State ______________ Zip Code __________ Day Number _____________________________ Evening Number _____________________ Email Address ________________________________________________________________ Do you belong to a Self-advocacy group? What is your role? Check a box.
□ Yes □ No
Name: ________________________
□
Self-Advocate
□ Professional
□ Family Member
Name of Emergency Contact: __________________________________________________ Cell/Home Number ____________________________________________________________ Accommodations: Do you need a sign language interpreter? ____ Yes ____ No Any other accommodations necessary? ___________________________________________ Registration Fee: Registration fee includes conference materials and tote, breakfast, lunch and reception. Membership fee covers a one-year membership in Project ACTION!, free trainings, meetings, and more. _____ Registration $ 25.00 _____ Project ACTION! Membership Fee $ 25.00 TOTAL FEES INCLUDED $ ________________ If you need financial assistance to attend, please call Victor Robinson at 202-459-4003 Payment Method: _____ Check or Money Order Enclosed [Payable to Quality Trust] _____ Credit Card Payment [Visit https://www.dcqualitytrust.org/pages/page05e2.cfm]
Mail to: Quality Trust for Individuals with Disabilities Attn: Project ACTION! 5335 Wisconsin Ave, NW, Suite # 800 Washington, DC 20015 Phone: 202-459-4003 or 202-448-1458 Fax: 202-448-1451
The Conference is funded in part by a grant from the Catholic Campaign for Human Development.
Turn over for more information.
Come and Experience the Power of Self-Advocacy
Ten Reasons to Attend.
1. 2. 3. Learn more about the Power of Self-Advocacy with other self-advocates. See folks you haven’t seen in a while, enjoy great food, and attend workshops. Want to know how to get your staff to take you more seriously? Attend a workshop and learn how. Want people to stop speaking for you? Attend the “Finding Your Voice” workshop and learn how. Check out the Exhibit Area and get resources, give-aways and great advice. Learn what your rights are, how to speak up for your rights and how to complain when you are taken advantage of, discriminated against on the job, and other times you weren’t treated like you thought you should have been. Learn how to defend yourself and to be safe in the community. Attend the “Personal Safety” workshop. The Power of Self-Advocacy Conference is going to be; the place to be on June 12! Learn how to be prepared for an Emergency such as a snowstorm, a disaster and more. Attend the “Emergency Preparedness” workshop and get the tools you need. Learn how to lead your ISP meeting and decide who gets to attend. You can set the rules for your planning meeting by attending the “Leading your Own ISP” workshop.
4.
5. 6.
7.
8.
9.
10.
You Don’t Want to Miss It.
Register Today!
co-sponsored by the National School of Social Service, Center for Community and Social Justice Saturday, June 12, 2010 from 8:00am – 5:00pm
Catholic University of America’s Pryzbyla Center 620 Michigan Avenue, NE, WDC 20064 REGISTRATION FORM Registrant Information (Conference is intended for self-advocates) : First Name __________________________ Last Name _____________________________ Address _____________________________________________________________________ City _________________________________ State ______________ Zip Code __________ Day Number _____________________________ Evening Number _____________________ Email Address ________________________________________________________________ Do you belong to a Self-advocacy group? What is your role? Check a box.
□ Yes □ No
Name: ________________________
□
Self-Advocate
□ Professional
□ Family Member
Name of Emergency Contact: __________________________________________________ Cell/Home Number ____________________________________________________________ Accommodations: Do you need a sign language interpreter? ____ Yes ____ No Any other accommodations necessary? ___________________________________________ Registration Fee: Registration fee includes conference materials and tote, breakfast, lunch and reception. Membership fee covers a one-year membership in Project ACTION!, free trainings, meetings, and more. _____ Registration $ 25.00 _____ Project ACTION! Membership Fee $ 25.00 TOTAL FEES INCLUDED $ ________________ If you need financial assistance to attend, please call Victor Robinson at 202-459-4003 Payment Method: _____ Check or Money Order Enclosed [Payable to Quality Trust] _____ Credit Card Payment [Visit https://www.dcqualitytrust.org/pages/page05e2.cfm]
Mail to: Quality Trust for Individuals with Disabilities Attn: Project ACTION! 5335 Wisconsin Ave, NW, Suite # 800 Washington, DC 20015 Phone: 202-459-4003 or 202-448-1458 Fax: 202-448-1451
The Conference is funded in part by a grant from the Catholic Campaign for Human Development.
Turn over for more information.
Come and Experience the Power of Self-Advocacy
Ten Reasons to Attend.
1. 2. 3. Learn more about the Power of Self-Advocacy with other self-advocates. See folks you haven’t seen in a while, enjoy great food, and attend workshops. Want to know how to get your staff to take you more seriously? Attend a workshop and learn how. Want people to stop speaking for you? Attend the “Finding Your Voice” workshop and learn how. Check out the Exhibit Area and get resources, give-aways and great advice. Learn what your rights are, how to speak up for your rights and how to complain when you are taken advantage of, discriminated against on the job, and other times you weren’t treated like you thought you should have been. Learn how to defend yourself and to be safe in the community. Attend the “Personal Safety” workshop. The Power of Self-Advocacy Conference is going to be; the place to be on June 12! Learn how to be prepared for an Emergency such as a snowstorm, a disaster and more. Attend the “Emergency Preparedness” workshop and get the tools you need. Learn how to lead your ISP meeting and decide who gets to attend. You can set the rules for your planning meeting by attending the “Leading your Own ISP” workshop.
4.
5. 6.
7.
8.
9.
10.
You Don’t Want to Miss It.
Register Today!
