Alabama Autism Conference Registration Form

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Mail To:
Registration Services
The University of Alabama
Box 870388
Tuscaloosa, AL 35487

Please submit this entire page for your registration. For multiple registrations, please duplicate this form.

[ ]Mr. [ ]Ms. [ ]Dr. First:____________________________Middle Initial:_______Last:___________________________

Preferred Name/Nickname:____________________________

Company/Organization Name:______________________________

Mailing Address:________________________________City:____________________________State:______Zip:_________

Email Address:________________________________Phone:____________________________

Job Title:____________________________

[ ] Enclosed is a check for $____________________________ made payable to THE UNIVERSITY OF ALABAMA

[ ] Purchase order is attached.

[ ] Charge $___________________to credit card: [ ] MasterCard [ ] VISA [ ] American Express [ ] Discover

Card #____________________________Exp. Date (M/Y)____________________________

Security / Verification / CVV Code_______________(Three or four digit code on back or front of credit card.)

Authorizing Signature:______________________________________

Registration Type/Fee:

[  ] In-Person Attendance

[  ] Virtual Attendance

Registration Fee (check all that apply):

[  ]  $60   – Pre Conference Workshop on 02/27/2025 

[  ]  $149 – Early Bird – Main Conference, must register by February 7, 2025

[  ]  $199 – Standard Rate – Main Conference

[  ]  $75 – Student – Main Conference

[  ]  $135 – UA Employee – Main Conference

[  ]  $135 – Group Rate – Main Conference (Available for companies or organizations sending 3 or more people. Registrations must be submitted at the same time to qualify.)

Session ID:
Pre-Conference Workshop #CS-2502-AAPC01-01
In-Person Conference #CS-2502-AAC001-01
Virtual Conference #CS-2502-AACV01-01

*Do you have any dietary restrictions? [ Yes ]  [ No ]

*Do you have any accommodation requests? [ Yes ]  [ No ]

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 ehtownsend@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 Office of Teaching Innovation and Digital Education. Need our STAARS Vendor Number? Please use VC000118827 for UA Office of Teaching Innovation and Digital Education.

Questions? Contact Emily Townsend at ehtownsend@ua.edu.