Group Registration

Group Registration Form

Empowering Our Children
Sunday, November 2, 2008
8:30 AM - 4:30 PM

Temple Beth Emet
4807 South Flamingo Road
Fort Lauderdale, FL

Group Rate: $500.00 for groups up to 20

Group Rate Registration Deadline:
Midnight, Sunday October 25th

HOW TO REGISTER AS A GROUP:
1. The group contact person must initially register the group by filling out this form, choosing a group name and paying the group registration fee. If you are initially registering your group, please indicate "Group Registration" for Registration Type.

2. If all members of the group are attending the same breakout sessions together, the contact person indicates the session choices on this form when initially registering the group. Upon submission of this form and payment of the registration fee, your group registration is complete. When checking in at the conference, use your group name.

3. If members of a group are choosing different breakout sessions, the contact person indicates "various" for the breakout sessions when initially registering the group. After submission of this form and paying the registration fee, each member of the group must fill out and submit this form including contact information and breakout session choices. When members of a registered group are entering their individual information on this form, please choose "Group Member Registration" for Registration Type.

Dade County teachers seeking master plan points must register for those points separately, before the conference

Click here to register for Dade County Master Plan Points

Group Name:
Name:
Registration Type:		Group Registration Group Member Registration
Street Address:
City:
State:
Zip Code:
Telephone Number:
E-Mail Address:
Occupation:
		Note: We will reserve seats for the number of participants you indicate below. Please do not register for more participants than you have attending.
Number in Group:
		FOR GROUP REGISTRATION: If all members of your group will be attending the same breakout sessions together, please select your preferences below. If members of your group will be attending various breakout sessions, please choose "various" from the drop down boxes. FOR GROUP MEMBER REGISTRATION: Indicate your preferences below for your breakout sessions.
First Choice Session 1:
Second Choice Session 1:
First Choice Session 2:
Second Choice Session 2:
How did you hear about the conference?:
Method of Payment:		Check Paypay (Credit Card)






		I understand the resources presented in this conference are based on the training, research, personal and professional experiences of the speakers. I understand that if I have any questions regarding the appropriateness of using any of these recommendations, I will consult my physician, mental health counselor or health care provider. In addition, I understand this information is for educational purposes only and is not a substitute for medical or psychiatric care. To participate in Empowering Our Children I assume full responsibility for using these resources in a safe and effective way and release The Best You Can Be Foundation, RCB of South Florida and Temple Beth Emet from any liability which may occur at this event. Reservations cancelled by midnight, October 11th will be refunded minus a $50 handling fee. There are no refunds following that date. Your reservation is transferable or you may choose to receive the audiodownload of the conference.
If you heard about the conference from your child's school, please enter name of school:
Continuing Education:		Master Plan Points Miami-Dade Teachers CEU's Nurses Inservice Hours Pre-School Teachers Inservice Hours Childcare Providers None

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