18th Annual Alabama Autism Conference


2.22.19


Alabama Autism Conference

February 22, 2019 Bryant Conference Center 240 Paul W. Bryant Dr. Program#: X3-034-19


EXHIBIT BOOTHS

[ ] $500 Exhibit Booth

1 Registration Package

[ ] $150        Additional Booth Personnel

SPONSORSHIPS

[ ] $9,500       Presenting Corporate Sponsor

6 Registration Packages

[ ] $5,000      Diamond Sponsor

5 Registration Packages

[ ] $2,500      Platinum Sponsor

4 Registration Packages

[ ] $1,500      Gold Sponsor

3 Registration Packages

[ ] $1,000      Silver Sponsor

2 Registration Packages

[ ] $800       Bronze Sponsor

1 Registration Package


REGISTRATION OPTIONS


Register Online autism.ua.edu


Register by Phone

205-348-3000

1-866-432-2015


Register by Mail

Registration Services, The University of Alabama

Box 870398, Tuscaloosa, AL 35487


First:                                                            

Middle Initial:

Last:                                                            

(Mr.) (Ms.) (Dr.)

Preferred Name / Nickname:

Company/Organization Name:

Mailing Address:

City:

State:

Zip:

Email Address:

Phone:

Job Title:


How did you find out about this program?

[ ] Enclosed is a check for $ made payable to THE UNIVERSITY OF ALABAMA [ ] Charge $ to credit card: [ ] MasterCard [ ] VISA [ ] American Express [ ] Discover Card # Exp. Date / Security / Verification / CVV Code        (Three or four digit code on back or front of credit card.)

Authorizing Signature:


A certificate verifying attendance and contact hours will be issued to all participants. Note: The University of Alabama is committed to complying with the Americans with Disabilities Act. Requests for accommodation of physical and/or dietary needs should be made at least 30 calendar days in advance of the program date. Please email your request to vchavis@ccs.ua.edu. A portion of the invoice amount for this program will go to the Capstone Lifelong Learning Foundation to support activities of The University of Alabama and the College of Continuing Studies. Need our STAARS Vendor Number? Please use VC000118827 for UA College of Continuing Studies.


CONTACT INFORMATION FOR SPONSOR ATTENDEES


Name:________________________________

Title:_________________________________________________________

Email:___________________________________________

Name:________________________________

Title:_________________________________________________________

Email:___________________________________________


Name:________________________________

Title:________________________________________________________

Email:__________________________________________

Name:________________________________

Title:________________________________________________________

Email:__________________________________________


autism.ua.edu


THE UNIVERSITY OF ALABAMA

College of Continuing Studies


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