WrightsLaw Conference Registration Form $125 Per Person Register Deadline is April 6th, 2015 A registration form needs to be filled out by EACH individual attending the conference Name of attendee:_____________________________________________________________________ Address:_________________________________ City, State, Zip:________________________________ Phone:__________________________________ Email:________________________________________ I am a: Parent Family Member Educator Lawyer Therapist Service Provider Other:__________ I am a legal professional requesting the maximum of 7 hours of CLE for an additional $50 Yes No N/A I am an Educator requesting CEU’s through JCCC for an additional $20 Yes No N/A Please list the primary disability of the person that brought you to this conference: Registration Scholarships (Limited number available) Registration scholarships are available to those requesting assistance to attend the WrightsLaw Conference. Scholarship requests are open to Greater Kansas City area residents only, and MUST BE RECEIVED BY MARCH 16TH to be considered. Applicants will be notified of their scholarship status by March 30th so they can plan accordingly. Please give a brief description of why this scholarship is important to you: Registration Deadline is April 6th! I have enclosed a check made payable to DSG I am requesting a scholarship School District ______________________________ Purchase Order#______________________ Please Charge my Visa or MasterCard # : _________________________________________________Exp._________ Name on Credit Card: ____________________________ CVV# __________ Billing Zip Code:___________________ Mail payment and registration form to: 5960 Dearborn Street Suite 100 Mission, KS 66202 Questions about the conference? Contact the DSG Center at 913-384-4848 Fax Registration Forms Back to 913-384-4949 Registration $125 per person $ $125.00 Includes the following: • 4 Books • All Day Conference • Breakfast • Lunch I am requesting either the $50 CLE or $20 CEU $_______ Total enclosed/charged to my credit card $_______ No refunds will be granted after April 1st.