28th Annual Conference and Meeting San Francisco Airport Marriott March 5 – 6, 2010 Keynote Speakers: Ellen Goldblatt and Dr. George Singer Hotel: San Francisco Airport Marriott Address: 1800 Old Bayshore Highway, Burlingame, CA 91410 Hotel Information Room Rate: $129.00 until February 4, 2010 Reservations: (650) 692-9100 or (800) 228-9290 – be sure to mention Cal-Tash to get the conference rate! Conference Registration Form PLEASE COMPLETE ALL INFORMATION REQUESTED BELOW: Are you currently a member of TASH/CALTASH? Your Name Phone Number Yes___ No___ Address E-mail Are Sign Language interpreter services needed? YES NO Circle the appropriate box; indicate if full day or one day only International TASH Member Rates Full Conference Friday or Sat only Non Member Rates Full Conference Friday or Sat only Early Bird Rate (until 1/31/2010) $175 $100 Early Bird Rate (until 1/31/2010) $220 $125 $265 $150 $220 $125 After 1/31/2010 After 1/31/2010 Person with Disability, Family Member, or Direct Assistant to Person w/Disability Full Conference $115 Friday or Saturday only $65 Teams of Five (5) 5 people registering together at the full conference rate – 6th person is free! All registrations forms must arrive together in the same envelope DONATIONS Would you like to make a tax-deductible denotation to support a selfadvocate or a parent attend the conference? YES: $_________________ TOTAL AMOUNT DUE (check or money order only) Conference Registration Donation Amount of Check $___________________ $___________________ $___________________ Mailing Information Please mail form along with your check or money/purchase order NO LATER THAN February 20th & make payable to Cal-TASH (no credit cards) to: LORI HANEY CONFERENCE REGISTRATION 6219 AVENIDA GORRION GOLETA, CA 93117 Refunds, less 25% processing fee will be made for cancellations prior to 2/11/10. Refund Information E-mail CAL-TASH at: firstname.lastname@example.org. Cal-TASH is vendored by the Regional Center System (DDS) of California. Call Regional Center Case Manager/Service Coordinator to request support. Our regional center vendor number is PW2184. Questions?