2021 Conference Registration

2021 Conference Registration

Virtual Conference
Registrations will NOT be accepted past
March 19th, 2021

* items are required
Date

Month Day Year
Date
Name *

First Name Last Name
Billing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
E-mail - conference information will be sent to this email *
Agency/School *
ESC Region *
If you are self-employed or retired and you are responsible for your own registration fee, please fill in your personal information below.
Billing information same as personal information. *

yes no
Billing Office Contact Name *

First Name Last Name
Billing Office Phone Number *
Billing Office Contact E-mail *
Check All that Apply: *

TVI COMS LVT RT Paraeducator Parent Student
Accommodation Request

Closed Captioning No Accommodated Materials Needed
Registration - $20 late fee after March 1st (Check as Appropriate) *

AER Member - ACVREP CEUs and CPEs (continuing professional education) available ($75) AER Non-Member - ACVREP CEUs and CPEs ($120) Student/Paraeducator/Parent/Guardian - CPEs Only ($50)
AER Member Number
Special Registration Code
Choose a pre-conference session: *ONLY SELECT ONE SESSION

Cost: $15
Mailing Address same as Billing Address

yes no
Mailing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Pre-Conference Selection
Please double check your options for the pre-conference and select only 1 spot
Pre-Conference Fee
Late Fee:
Sub-Total
Payment Method *

Online Purchase Order Check
PO Number
Upload PO
3% fee
Total
A 3% fee will be added to the sub-total if processing payment

using a credit card. It will show up in pay-pal as a shipping cost.

Sub-Total - {subtotal}

3% Fee - {fee3}

Total - {total}
Total Payment

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USD

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Comments
Registrations will NOT be accepted past
March 19th, 2021
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