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44th National Adapted Physical Education Conference
“Integrate, Innovate, Inspire-Get IN the Game with APE”
Hyatt Regency Orange County – Garden Grove, CA
November 19-21, 2015
Name
Last
First
Address
City
State
Work
(
Zip
Home
)
(
)
Email
Employer/College
CAHPERD/AAHPERD or other state HPERD Membership ID# & expiration date (required to register at member rate)*:
Early Registration Rates**
Payment Option:
Early Registration postmark deadline date is 10/22/15.
Make checks or purchase orders payable to CAHPERD
or fill in credit card information below.
Please check appropriate boxes.
A.
B.
C.
D.
E.
F.
Professional CAHPERD Member
Professional Non-CAHPERD Member*
Speaker (must have received letter)
Retired CAHPERD Member
Student CAHPERD Member
Student Non-CAHPERD Member
$185.00
$220.00
$90.00
$90.00
$90.00
$100.00
NOTE: If registering in categories above, MEALS ARE INCLUDED.
Please check the box(es) below to indicate which meal(s) you will
attend. Meal tickets are NOT guaranteed if boxes are not checked.
Check Meal Function(s) you will attend:
Thursday Social
Saturday Awards Luncheon
NOTE: Guest meals can be purchased by checking selections below.
G.
Meals (Guests)
$90.00
NOTE: By paying member dues below, you are qualified for
Member Registration Rates listed above (A, D, or E).
One Year New/Renew CAHPERD Membership Dues*:
H.
I.
J.
__________
Professional CAHPERD Membership
Retired CAHPERD Membership
Student CAHPERD Membership
$89.00
$44.50
$34.00
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COMPLIMENTARY ON-LINE SYLLABUS
Syllabus will be available the first day of the conference.
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Registration Total
$
Early Registration postmark deadline date is 10/22/15.
HOTEL INFORMATION:
Hyatt Regency Orange County
www.cahperd.org
Group rate available until October 28, 2015.
Subject to Availability.
Phone: 888-421-1442 or 714-750-1234
Credit Card #
Credit Card Expiration Date (MM/YY)
Name on Credit Card
Signature (required only for credit card transactions)
Mail Early Registration with Payment to:
CAHPERD
1501 El Camino Avenue - Suite 3
Sacramento, CA 95815-2748
or FAX to 916-922-0133
Early Registration postmark deadline date is 10/22/15**
After 10/22/15 registration is only available on-site.
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S PECIAL N EED A CCOMMODATIONS
Check if reasonable special need accommodations are
requested and describe
__________________.
(Must be requested by 10/22/15 to guarantee service.)
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*CAHPERD member registration rates may be obtained for nonmembers if CAHPERD membership is paid at the time of conference
registration (A+H, D+I, or E+J). Contact the CAHPERD State Office
for any membership questions by telephone, (916) 922-3596 or e-mail
[email protected]. AAHPERD and other state’s HPERD
membership are honored with proof of membership.
**All forms for Early Registration must be submitted with payment (Check,
PO, or Credit Card) and postmarked or faxed by 10/22/15. Registrations
by Card or PO may be sent by fax to (916-922-0133) and must be
received by 10/22/15. If you are unable to meet this postmarked deadline,
registration is only available on-site. No exceptions. On-site registration
rates will be $60 higher in all categories, EXCEPT Retired and Student.
On-site registration does NOT guarantee tickets for meal functions.