Download registration form - FAX REGISTRATION AND ACCOMMODATION FORM

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					FAX REGISTRATION AND ACCOMMODATION FORM


The 42nd Banff International Conference on Behavioural Science: Autism                      SHARED ACCOMMODATION PARTNER
Spectrum Disorders: New Directions in Research, Clinical Practice and                       The Banff Centre will charge the single rate should your chosen sharing delegate
Policy                                                                                      cancel. If you have selected Double accommodation, please name your chosen share
Conference Group Dates: March 21 ~ 24, 2010                                                 partner. ***Each share partner must complete his or her own reservation
                                                                                            form. ***
Booking ID: BVS1003 (The Banff Centre Use Only)
Reserve your accommodation by sending this completed form by
Fax        The Banff Centre Reservations Office (403) 762-7502
                                                                                            Triple/Quad Occupancy Request – please phone The Banff Centre Reservations: 1-
Mail       The Banff Centre Reservations Office, Box 1020, Stn. 15,
                                                                                            800-884-7574 for availability and price
           Banff, Alberta, Canada T1L 1H5
E-mail     reservations@banffcentre.ca
                                                                                            Your Accommodation selection will be confirmed by our reservations department
If you have any questions about your accommodation, please phone                            for availability and pricing prior to billing.
1-800-884-7574 or (403) 762-6308.
                                                                                            ACCOMMODATION REQUEST DATES

                                                                                            Please note that check-in is after 4:00 pm, check-out is by 12:00 noon.
 Name

 Title/Position                                                                             Arrival Date (mm /dd /yy)
 Organization/                                                                              Departure Date (mm /dd /yy)
 Institution
                                                                                            Will you be accompanied by a *spouse/companion?                   yes       no
 Mailing Address
                                                                                            *No charge to spouse if sharing room with a single delegate, does not include meals
 City/Province/State                                                                        for spouse, see Pre & Post and Companion Meals below.

 Country                                                                                    Please indicate if you plan to bring your children
 Postal Code/                                                                                     yes - ages:                                          no
 Zip Code

 Telephone                                         Fax                                      CONFERENCE REGISTRATION AND WORKSHOP FEES
                                                                                            Registration includes attendance at all sessions (excluding workshops which are
 E-mail                                                                                     bookable separately at $55.00 CAD each), buffet lunch and two coffee breaks daily.
                                                                                            For those requesting the student rate, you will be asked to provide current student
 Confirmation of accommodation reservation will be sent by e-mail within                    identification at the conference registration desk. All conference registration fees
 three working days to the address entered below. If you wish, you can have                 must be paid at time of registering.
 it sent to another address entered below.
                                                                                            Registration Type                   Early (Before February 26/2010) After
 Additional E-mail                                                                          Regular                             $350.00                  $380.00
                                                                                            Student/Resident/Interns            $120.00                  $135.00
DELEGATE DIRECTORY
Participant lists will be distributed to all delegates at the conference. Please indicate   Day Registration (1 DAY ONLY)
whether you want your name to appear on the list.                                           Regular/Student One-Day     $135.00                             $135.00

My name may appear on the delegate list            yes            no                        Mon, March 22        or    Tue, March 23        or Wed, March 24

If left blank, your name will NOT appear in the Directory.                                  Day registration fee includes lunch, two coffee breaks, service charge and tax. Full
                                                                                            registration fee is required if booking more than one day.
ACCOMMODATION/MEAL PACKAGE RATES ~ March 21 - 24, 2010
(Day 1, Day 2, Day 3, and Day 4)                                                            RECEPTION & BANQUET ~ Tuesday, March 23, 2010
The Package includes three nights accommodation (commencing Sun                             One ticket is included in your accommodation package for those staying at The
March 21), three Vistas buffet breakfasts, three Vistas buffet dinners and a                Banff Centre. Off site delegates must purchase a banquet ticket in advance.
plated Banquet Dinner (Tue March 23), service charges, wireless internet                    Companions are also invited to attend the banquet; however, you must purchase
access in bedrooms, parking, and access to the Sally Borden Recreation                      their ticket in advance.
Facility. Prices are exclusive of 5% GST, 4% Alberta Tourism Levy Tax, 2%
Tourism Improvement Fee and are quoted in Canadian Dollars (CAD). Meal                      Will YOU be attending the Banquet?                   yes           no
package commences Sunday, March 21, with Vistas buffet dinner and ending with
Vistas buffet dinner on Wednesday March 24.                                                 Meal Pre-selection: Please choose your dinner selection for the Banquet

Superior Room (Professional Development Building)                                               Grilled Supreme of Chicken          Grilled Fillet of British Columbia Salmon
   Single $191.30 (Day 1) $191.30 (Day 2) $232.01 (Day 3) $132.00 (Day 4)
   Double $128.80 (Day 1) $128.80 (Day 2) $169.51 (Day 3) $69.50 (Day 4)                    BANQUET GUEST - If you would like to purchase additional tickets for
                                                                                            this event, please indicate the number required:
Standard Room ~ (Lloyd Hall)
   Single $181.30 (Day 1) $181.30 (Day 2) 222.01 (Day 3) $122.00 (Day 4)                          x Ticket @ $50.00 (CAD) each (service charge and GST included)
   Double $123.80 (Day 1) $123.80 (Day 2) $164.51 (Day 3) $64.50 (Day 4)
                                                                                            Meal Pre-selection for Guest: Please choose your dinner selection for the Banquet
   I will be arranging my own accommodation off-site.
                                                                                                 Grilled Supreme of Chicken          Grilled Fillet of British Columbia Salmon
Single rate is for delegates not sharing accommodation with another delegate.
Double rate is per delegate sharing accommodation with another delegate.
FAX REGISTRATION AND ACCOMMODATION FORM
WORKSHOP REGISTRATION
Check off the workshops you wish to attend. The workshop fee is $55.00 (CAD)                                       Expiry          ______        Signature            _______________________________
for each. Please choose ONE workshop ONLY per slot as they are scheduled
concurrently.                                                                                                      How will you be GUARANTEEING your ACCOMMODATION?
                                                                                                                        The same method as conference registration
Monday, March 22, 2010 / 1:30 ~ 4:30 pm
                                                                                                                        Different: Please fill in the information below:
   A. “The Assessment and Treatment of Comorbid Mental Health
Problems in ASD” Peter Szatmari, McMaster University                                                                    Credit Card
                                     OR                                                                                 Cheque (payment required before February 15, 2010)
   B. “The Social ABCs: A Parent-Mediated Intervention for Toddlers with
Suspected Autism” Susan Bryson, Dalhousie University and Jessica Brian,                                            Please enter your credit card information:
University of Toronto
                                                                                                                                       American Express                             VISA
Tuesday, March 23, 2010 /9:00 am ~ 12:00 pm
                                                                                                                                       En Route / Diners Club                       Master Card
   C. “Early Behavioral Intervention: Neuroscience Principles and Practical
Applications” Wendy Stone, Vanderbilt University and Pat Levitt, University of                                     Name of Cardholder
Southern California
                                       OR                                                                          Card Number
   D. “Planting Two Trees with One Seed: Communication Supports for Problem
Behavior” Pat Mirenda, University of British Columbia                                                              Expiry          ______        Signature            _______________________________

Tuesday, March 23, 2010 /1:30 pm ~ 4:30 pm                                                                         SPECIAL ACCOMMODATION / MEAL REQUEST

   E. “Risk and Early Development in ASD” Lonnie Zwaigenbaum, University of                                        If you require any special dietary arrangements (for example, vegetarian meals,
Alberta                                                                                                            gluten-free meals), please specify.
                                    OR                                                                             _________________________________________________________________
   F. “Examining Maternal and Family Care for Young Persons with Autism: Shifts
over Time” David Nicholas, University of Calgary                                                                   If you have any special physical /mobility requirements, please specify:
                                                                                                                   _________________________________________________________________
Wednesday, March 24, 2010 / 1:30 ~ 4:30 pm

   G. “Technology and Community-Based Instruction to Support Older Learners                                        SPECIAL PRE AND POST CONFERENCE RATES
with Autism” Peter Gerhardt, Organization for Autism Research and Avi                                              The Banff Centre will extend the conference rate to cover the periods that are three
Glickman, PAAL (Preparing Adolescents for Adult Life)                                                              days before Sunday, March 21, 2010 and three days after Wednesday March 24,
                                                                                                                   2010, subject to availability. Prices are room rate only (based on single/double) and
                                       OR                                                                          do not include any meals, gratuities or taxes.
   H. “Asperger Syndrome: Parent and Provider Perspectives” Susan Carpenter,
University of Calgary and Sharon Nagel, Sinneave Family Foundation                                                 Room rates        Superior            $125.00 (CAD) per room per night
                                                                                                                                     Standard            $115.00 (CAD) per room per night
PAYMENT PROCEDURES
                                                                                                                   Pre & Post and Companion Meals at Vistas Dining Room
Conference Registration and Workshop Fees:                                                                         Meals are not included for delegate spouses/companions. Individual meals can be
Payment is REQUIRED in advance and will be processed at the time of                                                purchased in the Vistas Dining Room, Marché meal rates: Breakfast $16.75,
registration when you are paying by credit card. If wanting to pay by cheque, your                                 Lunch $20.75, Dinner $36.75 + 5% GST
registration form must be received by The Banff Centre by February 15, 2010.
Please make payable to “The Banff Centre,” and send payment to: Reservations, The                                  TAXES
Banff Centre, Box 1020, Banff, Alberta T1L 1H5.                                                                    a) The Banff Centre will charge GST on accommodation and packages. Canada
                                                                                                                   imposes this Goods and Services Tax (GST) of 5% on all purchased goods and
Accommodation:                                                                                                     services while in Canada.
The Banff Centre REQUIRES your credit card information OR a cheque made                                            b) Alberta imposes an “Alberta Tourism Levy Tax” (ATL) of 4% on all
payable to "The Banff Centre" in Canadian Funds equivalent to one night’s stay                                     accommodation charges. ATL will not apply to “room cancellation fees.”
(room portion only), in order to guarantee your reservation. You may send a                                        c) The Tourism Improvement Fee (TIF) of 2% is applied to all accommodation
cheque; however, confirmation of your accommodation reservation will not be sent                                   charges.
until payment has been received and processed by the Reservations Department.                                      d) Taxes are beyond the control of The Banff Centre, and may change without
                                                                                                                   notice.
Purchase Orders (PO): Any delegate providing PO information when registering
must provide full payment PRIOR to February 15, 2010. Confirmation of                                              CANCELLATION POLICY
registration will NOT be confirmed until payment has been received; any payments
not received by February 15, 2010 will result in cancellation of                                                   Conference Registration/Workshop Fees/One Day Registration:
registration/accommodation.                                                                                        For cancellation requests received by The Banff Centre on or before February 26,
How will you be paying for your CONFERENCE REGISTRATION Fees?                                                      2010 the registration and workshop (if applicable) fees will be refunded less an
                                                                                                                   administration charge of $68.25 (CAD). There will be no refund of any portion
                   Credit Card                                                                                     of the registration and workshop fees cancelled after February 26, 2010.
                   Cheque (payment required before February 15, 2010)                                              Accommodation:
                                                                                                                   Room cancellation must be received at least 48 hours prior to your scheduled
Please enter your credit card information:                                                                         arrival. Reservations cancelled less than 48 hours prior to arrival will be subject to a
               American Express                                  VISA                                              charge equivalent to one night’s stay, plus taxes.
                   En Route / Diners Club                        Master Card
                                                                                                                   Additional Comments: (Comments or Questions)
Name of Cardholder
Card Number

The personal information on this form will be used for the purposes of managing your accommodation arrangements. The information is collected under the authority of the Post-Secondary Learning Act, Revised Statutes of Alberta,
that mandates the programs and services offered by The Banff Centre and will be protected by the provisions of the Alberta Freedom of Information and Protection of Privacy Act. For inquiries about the collection and use of this
information, contact the General Manager, Conferences, The Banff Centre, Box 1020, Station 11, Banff, Alberta T1L 1H5. Telephone: (403) 762-6435.

				
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