2027 Symposium Registration Form

2027 ACD Symposium Registration Form
Your Information
Are you a....
CCDS Diagnosis
Institution, Company, or Organization Name (if applicable):
First Name
Last Name

List all members of your party - Meeting space is limited to 250. Kids Camp is limited to 30, ages 3 and older. Please indicate in the "attendance type" column if each person will attend talks and meals, meals only, or kids camp.

Rows	Full Name	Age	Attendance Type
1
2
3
4
5

Email
example@example.com
Phone Number

Country CodeArea CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
If offered, would you be interested in attending a family welcome dinner on Friday, Sept 3? (Will schedule based on interest)
Special Needs
What is your language preference?
Would you like a translator?
Registration

2027 Symposium Registration Fee. The registration fee is per family, not per person. One fee covers all family members who live in the same home and attend together.

CCDS Family

$25.00 Quantity

Academics

$250.00 Quantity

Industry (individuals affiliated with for-profit entities, private institutions, and pharmaceuticals)

$500.00 Quantity

Make an additional donation of support

$100.00 Quantity

Enter coupon

Total

Payment Methods
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Acknowledgment of Event Participant Responsibility, Express Assumption of Risk, and Release of Liability
Should be Empty:

2027 ACD Symposium Registration Form

Your Information

Special Needs

Registration

2027 Symposium Registration Fee. The registration fee is per family, not per person. One fee covers all family members who live in the same home and attend together. *

Acknowledgment of Event Participant Responsibility, Express Assumption of Risk, and Release of Liability

2027 Symposium Registration Fee. The registration fee is per family, not per person. One fee covers all family members who live in the same home and attend together.