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PADES Registration

Registration

PERSONAL DETAILS

First Name
Middle
Last Name

Business / Organization

Title

ADDRESS

Street

City
State
ZIP

CONTACTS

Email
Phone
Fax


ATTENDEE TYPE


What is your interest in PADES?

If you selected "Other", please share more details:

REGISTRATION OPTIONS

Please select all the days you plan to attend:

SPECIAL NEEDS

Please specify any special dietary restrictions you have:

Please specify any special accommodations you require:

How did you hear about the event? Please check all that apply.

If you selected "Other", please share more details:

Are you a member of The Arc?

 

Hotel Reservations

The Hershey Lodge has kindly agreed to offer our summit attendees a special room rate for the duration of the event: $169.00 plus taxes per night between Wed Oct 3-Sat Oct 6 (four nights). You may call them directly at 1-800-HERSHEY and reference “PADES”. Please note that reservations must be made by September 04, 2012.