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 firstname.lastname@example.org 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.