Name
*

Organization You Are Representing

Mailing Address
*

City, State, Zip
*

E-mail

Daytime phone
*

Status (you may choose more than one)
 Parent/Guardian
 Special Educator
 Regular Educator
 Student
 Health Professional
 Administrator
 Adult Service Provider

Morning Workshops (Choose One)
 1. No IEPs in College - High school and college obligations differ
 2. Getting the Job Right - Straight talk about employment
 3. Healthcare & Transition - What's health got to do with it? Everything!
 4. Financial Planning - A roadmpap for those with special needs

Afternoon Workshops (Choose One)
 5. Attending College - Where students can find the help they need
 6. On the Job - What it takes to be successful
 7. Becoming Independent - What youth need to know
 8. Healthcare Financing - Almost everything you've ever wanted to know

Conference Fee (Choose One)**
 Educator/Professional $90
 Parent/Guardian/Student $45

**If you are both a professional and a parent/guardian, and your organization
is paying your registration fee, please select the $90 Conference Fee.

A limited number of scholarships are available for parents and students. Contact VPIC at 1 (800) 639-7170, (802) 876-5315 or e-mail kdutton@vtpic.com.

Method of Payment
 Check/Money Order
 Credit Card (MasterCard or VISA)
 Purchase Order

If you are paying by credit card, you will be contacted by phone to
gather your information.

If sending a check or purchase order, please mail to:

VPIC
Charting the Course
600 Blair Park Road
Suite 301
Williston, VT 05495-7589


See you at the conference!


Please print this page for your records before submitting.