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ADVANCED PROGRAM

REGISTRATION FORM

2007 DISABILITY ACCESS
CONFERENCE
Design for All
September 6, 2007
Ala Moana Hotel
8:30am - 4:30pm

Feel free to copy this form for additional registrations. USE ONE FORM PER PERSON. Please print or type.

Name: _______________________________________________________________________
            Last, First

Affiliation:_____________________________________________________________________

Mailing Address: _______________________________________________________________

City/State/Zip Code: _____________________________________________________________

Phone: ________________ Fax: _________________ E-mail: ___________________________

Check here if you’d like to receive DCAB’s quarterly Access Bulletin & local/national updates via e-mail.

If you require an auxiliary aid (sign language interpreter, material in alternate format, etc.) or accommodation due to disability, please describe, ___________________________________.
Deadline for request is August 23, 2007

Please register me for the following:
(Registration includes Continental Breakfast/Plenary Session, Lunch/Design Awards & 4 Break-out Sessions)
$75 General
$40 Student or Persons with Disabilities (Limited to the first 30 registering)

I am registering for the following sessions (Refer to Schedule at a Glance for Session #):
(Pre-selection assists presenters in preparing materials and providing accommodations.)

	First Choice	Second Choice
9:45a.m. - 10:45 a.m.	# ______	# ______
11:00 a.m. - Noon	# ______	# ______
2:15 p.m. - 3:15 p.m.	# ______	# ______
3:30 p.m. - 4:30 p.m.	# ______	# ______

Form of Payment
Check made payable to the University of Hawaii
Purchase order (must accompany registration)
I hereby authorize University of Hawai’i the use of my credit card account:

VISA MasterCard | Expiration Date (Month/Year) _____________

Credit Card No. ____________________________________CCV__________________

Name ___________________________________________________________________
              Signature, Print Name

Send registration form and payment to:
UH Conference Center
2530 Dole St., Sakamaki C403, Honolulu HI 96822
(808) 956-8204 [phone]; (808) 956-3364 [fax]; UHCC I.D. #C0 8780
REGISTRATION DEADLINE: AUGUST 23, 2007
Space limited to the first 230 registrants