CONTACT INFORMATION
Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
CHILD CARE FACILITY INFORMATION
Name of Facility
*
Address of Facility
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Does your facility accept vouchers?
*
Yes
No
CONFERENCE SPECIFIC INFORMATION
PDR Number
*
Participants must have a valid PDR number to receive training credit.
What is your age or area focus?
*
Infants
Toddlers
Preschool
School-Age
Family Child Care Home
Administration
Other
Conference Name Badge Information
*
First Name
Last Name
Child Care Facility Name
*
CANCELLATION POLICY *Read carefully
To cancel your registration, you must contact Amy Pinkston at (870) 793-5233 or apinkston@wrpdd.org no later than 12:00 p.m. on Friday, September 27th. You can also send someone in your place if you are unable to attend. Please contact us if sending a replacement.
PAYMENT INFORMATION
The cost of the conference is $20 per participant with Early Bird Pricing (available through June 15th). After June 15th, conference registration is $25 per participant. Registration must be completed no later than Friday, September 20th. We CANNOT accept payment on site. Online payments are processed using the following link: https://www.zeffy.com/en-US/ticketing/8dd25b2c-4ca9-4eee-8457-555417a0a4fa. You may pay online using any major credit/debit card, US bank account, or Google Pay. You may also pay by check. Check payments must be received no later than ONE WEEK prior to the event. To pay by check, make a check payable to "Child Care Aware of Northcentral Arkansas" and mail to the following address. Include a note with your name or names if paying for multiple participants. Send checks to: Child Care Aware of Northcentral Arkansas, PO Box 2396, Batesville AR 72503.
How do you wish to pay?
Pay online using link
Check sent by mail
How many participants will you be paying for?
If paying for more than one participant, please list names of each participant (separate by comma):
(For example: Jane Doe, John Doe, etc.)
Submit
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