2014 AG Bell Convention Registration Brochure
Register today and join us for the most magical event of the year - the 2014 AG Bell Convention in Orlando, Florida, June 26-30!
2014 AG Bell Convention June 26-30, 2014 Walt Disney World Swan and Dolphin Orlando, Florida REGISTRATION BROCHURE More value for everyone in 2014 • • • • • • • • Back by popular demand! Up to two badges for just one registration fee (applies to families of children with hearing loss and adults with hearing loss) 10 pre-convention workshops and 48 concurrent sessions for families, individuals with hearing loss and professionals Over 70 exhibitors in the areas of hearing technology, education and materials Magical venue: Walt Disney World Swan and Dolphin resort— stay where the magic is happening! Onsite Children’s Program Keynote presentation by Rosalind Wiseman, best-selling author and an internationally recognized expert on children, teens, parenting, bullying and social justice Research Symposium featuring the latest research on maximizing brain adaptability and enhancing listening for language development, speech perception and music appreciation Up to 22.5 hours of continuing education 2014 AG Bell Convention • June 26-30, 2014 • Walt Disney World Swan and Dolphin • Orlando, Florida David Davis, MLIS, Chair Evan Brunell Dan Collins Peg Diehl Maureen Doty-Tomasula, CCC-A, Au.D. Lisa Goldstein, M.J. Candace Haney, MCD, CCC-SLP, LSLS Cert. AVEd Chris Lehfeldt, DDS Carissa Moeggenberg, M.A., CCC-A Erik Nordlof Beth Otto, M.A. Sherra Payne, M.S.Ed. Becky Selenko Patricia Trautwein, Au.D. Lindsay Zombek, M.S., CCC-SLP, LSLS Cert. AVT •CONVENTION • OVERVIEW Every two years, the AG Bell Convention brings together a diverse community that is committed to listening and spoken language for children and adults who are deaf and hard of hearing. This is the only event of its kind that includes comprehensive educational programming featuring the latest evidence-based information and practice in the field of listening and spoken language. We invite you to attend the 2014 AG Bell Convention, June 26-30, at the Walt Disney World Swan and Dolphin resort in Orlando, Fla., and join more than 1,500 families of children who are deaf and hard of hearing, adults who listen and talk, and the professionals that support them. The theme for the 2014 Convention is Magic Made Real—Celebrating Our Heritage, Transforming Our Future. Join us as we acknowledge our pioneers and transformers and continue to pave the way into the future. This year’s convention brings back our popular registration option which offers up to two badges for one registration fee for families of children with hearing loss and adults with hearing loss. Highlights of the convention include the Research Symposium, the popular Children’s Program and many fun social events for everyone! Be sure to visit the exhibit hall and explore new hearing technology, educational programs and other resources. Rosalind Wiseman, best-selling author and nationally recognized expert on teen social challenges, will be this year’s keynote presenter. She will share her insights on how to speak one’s truth with authenticity, conviction and dignity, and apply this to interactions with family, friends, teachers and classmates in a variety of everyday life settings. The convention venue—the magical Walt Disney World Swan and Dolphin Resort—is ideally situated just moments away from the thrill and excitement of the Walt Disney World® theme parks, offering convention attendees breathtaking tropical landscaping, tranquil waterways, classic art and architecture, and lots of perks for its guests. The resort is newly remodeled throughout, with stunning lobbies and unique new restaurants for every taste and budget! We look forward to welcoming you at the Walt Disney World Swan and Dolphin for AG Bell’s unforgettable, one-of-a-kind, all-in-one convention in Orlando! • • AG BELL 2014 CONVENTION COMMITTEE ListeningandSpokenLanguage.org/2014Convention • 202.337.5220 or 866.337.5220 2014 AG Bell Convention • June 26-30, 2014 • Walt Disney World Swan and Dolphin • Orlando, Florida SCHEDULE-AT-A-GLANCE Thursday, June 26 7:00 a.m. – 8:00 a.m. – 11:30 a.m. – 1:00 p.m. – 7:00 p.m. 11:30 a.m. 1:00 p.m. 4:30 p.m. Friday, June 27 7:00 a.m. – 7:30 a.m. – 8:00 a.m. – 11:30 a.m. – 12:00 p.m. – 1:00 p.m. – 2:30 p.m. – 3:00 p.m. – 3:00 p.m. – 5:30 p.m. – 6:00 p.m. 5:00 p.m. 11:30 a.m. 1:00 p.m. 12:45 p.m. 2:30 p.m. 3:00 p.m. 4:30 p.m. 4:30 p.m. 7:00 p.m. Saturday, June 28 7:00 a.m. – 7:30 a.m. – 8:00 a.m. – 10:00 a.m. – 10:00 a.m. – 10:30 a.m. – 12:00 p.m. – 12:00 p.m. – 12:00 p.m. – 1:30 p.m. – 3:00 p.m. – 3:30 p.m. – 6:00 p.m. – 8:30 p.m. – 6:00 p.m. 5:30 p.m. 10:00 a.m. 4:00 p.m. 10:30 a.m. 12:00 p.m. 1:30 p.m. 1:30 p.m. 1:30 p.m. 3:00 p.m. 3:30 p.m. 5:00 p.m. 7:30 p.m. 10:30 p.m. Sunday, June 29 7:00 a.m. – 5:00 p.m. 7:30 a.m. – 9:00 a.m. 7:30 a.m. – 5:00 p.m. 8:00 a.m. – 11:30 a.m. 9:30 a.m. – 3:00 p.m. 9:30 a.m. – 10:00 a.m. 10:00 a.m. – 11:30 a.m. 11:30 a.m. – 1:00 p.m. 1:00 p.m. – 2:30 p.m. 2:30 p.m. – 3:00 p.m. 3:00 p.m. – 4:30 p.m. 4:30 p.m. Monday, June 30 Leadership Day Registration Open Pre-convention Workshops (ticket required) Lunch (on your own) Pre-convention Workshops (ticket required) • •• Registration Open Children’s Program Pre-convention Workshops (ticket required) Lunch (on your own) First Timers Orientation Concurrent Sessions Break Concurrent Sessions Dena Goldstein Mixer (RSVP required) Welcome Reception in Exhibit Hall Registration Open Children’s Program General Session/Keynote Presentation Exhibit Hall Open Break/Exhibits Concurrent Sessions Poster Session Lunch (on your own) LOFT Reunion Lunch (ticket required) Concurrent Sessions Break/Exhibits Concurrent Sessions Happy Hour (ticket required) Club Volta (ticket required) Registration Open Breakfast with Friends (ticket required) Children’s Program Research Symposium Exhibit Hall Open Break/Exhibits Concurrent Sessions Lunch (on your own) Concurrent Sessions Break/Exhibits Concurrent Sessions Convention Sessions End Committee Meetings (by invitation) * Schedule subject to change. ListeningandSpokenLanguage.org/2014Convention • 202.337.5220 or 866.337.5220 1 2014 AG Bell Convention • June 26-30, 2014 • Walt Disney World Swan and Dolphin • Orlando, Florida RESEARCH SYMPOSIUM Maximizing Brain Adaptability Enhancing Listening for Language Development, Speech Perception and Music Appreciation Sunday, June 29 8:00 a.m. – 11:30 a.m. For the ninth convention in a row, AG Bell is pleased to present its renowned Research Symposium featuring eminent scientists in the field of hearing health research and auditory skill development. The 2014 Research Symposium chairmen, Peter Steyger, Ph.D., and Tilak Ratnanather, Ph.D., have once again invited an impressive panel of scientists to share their work with AG Bell convention attendees. Beverly Wright, Ph.D., Northwestern University, School of Communication, will present on brain plasticity in relation to auditory perceptual learning. Pamela Souza, Ph.D., Northwestern University, School of Communication, will present on improving audibility with hearing aids and/or cochlear implants as the necessary foundation for improving speech Kate Gfeller, Ph.D., University of Iowa, School of Music, will present on music appreciation with cochlear implants for children and adults. perception and comprehension. Emily Tobey, Ph.D., University of Texas at Dallas, School of Behavioral and Brain Sciences, will present on language outcomes for children who receive cochlear implants at an early age. The Research Symposium is included in the convention registration fee. 2 ListeningandSpokenLanguage.org/2014Convention • 202.337.5220 or 866.337.5220 2014 AG Bell Convention • June 26-30, 2014 • Walt Disney World Swan and Dolphin • Orlando, Florida NETWORKING EVENTS AND ACTIVITIES • • First Timers Orientation Friday, June 27 12:00 p.m.–12:45 p.m. Saturday, June 28 6:00 p.m.–7:30 p.m. If you have never attended an AG Bell convention before, or would like a refresher on how to make the most of your experience in Orlando, this orientation is for you! Learn how to navigate the schedule, set priorities and meet other newcomers. Designed for AG Bell’s professional members, the Happy Hour is a great time to meet up with old and new friends and colleagues! This event includes one drink ticket and light refreshments. Tickets are $25 per person. The Happy Hour is open to individuals 21 and older. Dena Goldstein Mixer Friday, June 27 3:00 p.m.–4:30 p.m. This reception is a wonderful opportunity for adults with hearing loss and teens with and without hearing loss to make friends, ask questions and share experiences in a relaxed and friendly social environment. The event is free of charge, but a ticket is required. (Made possible by the Dena Goldstein Memorial Fund.) • Exhibit Hall Grand Opening and Welcome Reception Friday, June 27 5:30 p.m.–7:00 p.m. Not to be missed! Join fellow convention attendees for a welcome reception and the grand opening of the convention exhibit hall. Build your excitement, catch up with old friends, make new friendships, and share it all with fellow attendees and exhibitors. Highlights include hors d’oeuvres, refreshments and a chance to explore the exhibit floor. Back by popular demand! Join the scavenger hunt, in which exhibitors hold the clues, and your completed answer cards will be turned in for multiple prize drawings. • • Happy Hour LOFT Reunion Lunch Saturday, June 28 12:00 p.m.–1:30 p.m. This event is for LOFT “graduates” and current and former counselors to catch up with old friends and make new connections with LOFT alumni. Immediate family members are welcome. Tickets are $25 per person. • Club Volta Saturday, June 28 8:30 p.m.–10:30 p.m. “Club Volta” is back and quickly becoming an AG Bell convention tradition! Designed especially for adults who are deaf and hard of hearing, this festive gathering is a special opportunity to meet up with longtime AG Bell pals and welcome new friends. After dinner on the town or in one of the Walt Disney World Swan and Dolphin’s fabulous restaurants, gather for an evening of friendship and laughter. This event includes one beverage ticket for wine, beer or soft drink; light hors d’oeuvres; and fun activities. Convention registrants and nonregistrants are welcome. Tickets are $35 per person for convention registrants and $50 per person for non-registrants. Club Volta is open to individuals 21 and older. • Breakfast with Friends Sunday, June 29 7:30 a.m.–9:00 a.m. AG Bell conventions have a special history of bringing together families who begin as strangers and end as lifelong friends. Don’t miss this opportunity to gather with other families who understand what it means to support listening and spoken language, and celebrate the magic made real. Enjoy a full breakfast buffet before starting your day of learning and networking. Tickets are $20 each for adults, $10 each for children ages 3–9, and free for children younger than 3. Please register by June 5 for this exciting event. ListeningandSpokenLanguage.org/2014Convention • 202.337.5220 or 866.337.5220 KEYNOTE SPEAKER Rosalind Wiseman Rosalind Wiseman is a best-selling author, sought-after speaker, and an internationally recognized expert on children, teens, parenting, bullying and social justice. In a general session presentation on Saturday, June 28, 8 a.m.–10 a.m., Wiseman will share her insights on how to speak one’s truth with authenticity, conviction and dignity, and applying this to interactions with family, friends, teachers and classmates in a variety of everyday life settings. Wiseman’s work aims to help parents, educators and young people successfully navigate the social challenges of young adulthood. Each year, she works with tens of thousands of students, educators, parents, counselors, coaches and administrators to create communities based on the belief that each person has a responsibility to treat themselves and others with dignity. In 2011, she was one of the principal speakers at the White House Summit on Bullying. Wiseman was most recently a featured contributor in the November 21, 2013, issue of TIME magazine. She is the author of Queen Bees and Wannabes: Helping Your Daughter Survive Cliques, Gossip, Boyfriends, and the New Realities of Girl World that was the basis for the movie Mean Girls. She is also the author of the newly released Masterminds and Wingmen: Helping Our Boys Cope with Schoolyard Power, Locker-Room Tests, Girlfriends, and the New Rules of Boy World, which deals with the social realities that boys face every day. 3 2014 AG Bell Convention • June 26-30, 2014 • Walt Disney World Swan and Dolphin • Orlando, Florida PRE-CONVENTION WORKSHOPS THURSDAY,JUNE JUNE 26 26, 1:00 P.M. - 4:30 P.M. THURSDAY, P.M.-4:30 P.M. THURSDAY, JUNE 26 8:00 A.M.-11:30 A.M. Bridging the Gaps: A Continuous Learning Model for the 21st Century LSL Professional Teresa H. Caraway, Ph.D., CCC-SLP, LSLS Cert. AVT Oberkotter Foundation Professional Learning Initiative Wendelyn DeMoss, M.S., CCC-SLP, LSLS Cert. AVT Oberkotter Foundation Professional Learning Initiative Kathryn Wilson, M.A., CCC-SLP, LSLS Cert. AVT First YEARS, University of North Carolina-Chapel Hill This workshop will discuss and analyze a practical framework as a tool that practitioners can use to rate their current practice and understanding against a set of descriptors. Participants will engage in discussions and explore how the leveling framework can inform a practitioner’s professional development plans and content of future learning. The workshop will focus on using 21st century learning skills for listening and spoken language (LSL) practitioners to become connected learners and contribute to the collective intelligence to transform LSL practice. Participants will be encouraged to bring their own device and actively engage in using 21st century tools to develop a professional learning plan based upon a well-constructed leveling rubric to facilitate continuous and ongoing improvement in their knowledge and skills so that child outcomes can be maximized. Tomorrow’s Magic Made Real Through Today’s Learning Amy Peters Lalios, M.A., CCC-A, LSLS Cert. AVT Center for Communication, Hearing & Deafness Pam Stemper, B.A. Know and Grow Institute, LLC When babies have continuous access to the sounds of their environment, parents witness the magic of children effectively learning 4 their home’s spoken language with seemingly little effort. As children begin school, parents hope and expect the “magic” to naturally continue through ongoing learning and development. For parents of children with hearing loss, these hopes and expectations can be uncertain. Through the collaboration of a parent and a certified auditory-verbal therapist, this workshop will address schemata (what one knows) to bring about the “magic” in development of spoken language, literacy, critical thinking and social skills in children with hearing loss. Focus will be on augmenting what we know about brain development, language, the innate abilities of children and parents, and on fostering an effective triad among parent, child and professional. It’s not Fine. It’s not OK. Krista S. Heavner, M.S., CCC-SLP, LSLS Cert. AVT North Carolina Department of Public Instruction, Division of Exceptional Children Sherri Vernelson, M.Ed., LSLS Cert. AVEd North Carolina Department of Public Instruction, Division of Exceptional Children Children with hearing loss attending mainstream public schools may be significantly behind their peers with typical hearing despite having good or even excellent spoken language abilities. Teachers and educators often assert, “He is doing fine,” “She is doing OK,” when the reality may be quite different. This workshop will discuss the specific needs of students with hearing loss in the classroom when a language delay greater than 1½ to 2 years exists through presenting case studies and videos; describe how consultants in North Carolina have addressed the needs for students with hearing loss within Local Education Agencies (LEAs) in a direct, data-driven, yet pragmatic manner; present recorded interviews with directors of divisions of exceptional children in LEAs who have implemented the plans recommended to IEP teams; and describe how small, yet significant changes have impacted outcomes for their students. Real-Time Embedded Coaching, It Really Works! Betsy Moog Brooks, M.S., CED, LSLS Cert. AVEd The Moog Center for Deaf Education This workshop will focus on the strategies and techniques of real-time embedded coaching, a method of “demonstration” and “return demonstration” to help parents enhance communication with their child. Embedded coaching is a term applied to coaching a parent or primary caregiver and providing suggestions, while s/he is engaged in an activity with a child, rather than waiting until after the activity is over. The early interventionist is providing support in realtime by making comments and suggestions throughout the activity. The workshop will discuss techniques for implementing embedded coaching into a parent-infant session; review the organization of the parent-infant session; provide guidance on how to capitalize on the parent’s/caregiver’s current skills and learning style; and discuss the importance of describing the critical features of the activity or technique being implemented to the parent/caregiver. Determining Eligibility: Considerations for the “Good Student” Karen L. Anderson, Ph.D. Supporting Success for Children with Hearing Loss Lynne H. Price, NBCT—Deaf & Hard of Hearing, K-12 Regular Education, and Reading As a result of Early Hearing Detection and Intervention (EHDI) increasing numbers of children with hearing loss are entering school with language skills commensurate to their peers with typical hearing. Yet, children with hearing loss face barriers to auditory access in mainstream classroom communications such as incidental learning that often result in social and emotional needs and accumulative functional learning challenges. Many of these students with hearing loss are no longer being found eligible for Individualized Education Programs (IEPs). Eligibility ListeningandSpokenLanguage.org/2014Convention • 202.337.5220 or 866.337.5220 2014 AG Bell Convention • June 26-30, 2014 • Walt Disney World Swan and Dolphin • Orlando, Florida necessitates both assessment of academic achievement and functional performance. For students with hearing loss, eligibility needs to consider communication needs, opportunities for direct communication with peers and the student’s full range of needs. This workshop will focus on functional assessment to inform the team of the student’s ability to access communication and his or her full range of needs. Strategies for how to make the case for specialized instruction will be provided. work and offer a hands-on practice with a dynamic technique called Motivational Interviewing. Participants will leave with new knowledge about the history and practice of Motivational Interviewing along with critical skills to help implement this method in their own practice to better help families of children with hearing loss work through the many changes and challenges in their journey of living a rich and fulfilling life. Hands-On: Apps and the iPad Theory of Mind and Pragmatics— Think About It! Lyndsey Allen, LSLS Cert. AVT The Ear Foundation Jack turns over his boiled egg and says “Look mommy, I didn’t eat it!” Chloe hides behind the sofa and her daddy starts the “Where’s Chloe gone” routine. Both of these scenarios show children who are developing key concepts in the Theory of Mind. This workshop will help participants identify five key concepts for preschool children and learn about the Theory of Mind Inventory online development measure and its use in research with children who are deaf and hard of hearing. The workshop will provide filmed examples of auditory-verbal therapy and give participants lots of new ideas they can put into practice for the children they serve. FRIDAY,JUNE JUNE 27 27, 8:00 A.M. - 11:30 A.M. FRIDAY, A.M.-11:30 A.M. Facilitating Change Through Motivational Interviewing Darcy Stowe, M.S., CCC-SLP, LSLS Cert. AVT Hearts for Hearing Lindsay Hanna, M.S., CCC-SLP, LSLS Cert. AVT Hearts for Hearing Steven Wells, Ph.D. University of Oklahoma Listening and spoken language professionals who work with children with hearing loss are continuously challenged to enhance their skills and stay on the edge of new knowledge, technology and approaches. Other professions often offer excellent tools and strategies to help hearing health professionals better serve families of children with hearing loss who seek a listening and spoken language outcome. This workshop will provide an opportunity to learn from the field of social Christine Gustus, M.S., CCC-SLP, CED, LSLS Cert. AVEd The Moog Center for Deaf Education Betsy Moog Brooks, M.S., CED, LSLS Cert. AVEd The Moog Center for Deaf Education Teachers and therapists are always looking for new ideas, activities, materials and ways of doing familiar activities. This workshop will focus on using an iPad to implement traditional teaching and therapy activities using new technology. The iPad may be used to practice skills in the areas of speech, vocabulary, language, literacy and listening. This workshop will focus on using apps appropriately within the context of a well-planned lesson and provide sample lesson plans for some of the apps under discussion. The apps will be presented through live demonstration and video and their advantages for teaching children with hearing loss will be explained. Participants will gain ideas for using specific apps and receive a list of apps that have been found to be successful. Attendees are encouraged to bring their iPads to the workshop for maximized learning. Real Magic: Transforming the Future Through Mentoring developed between mentors and the professionals they coach and guide, the magic begins! The Mentors Guide to Auditory-Verbal Competencies (Years 1-3), created by the course presenters, will be unveiled during this interactive presentation. The Mentor’s Guide is an assessment tool developed to aid mentors and mentees in tracking professional skill development over three years across nine critical areas. Participants will engage in small group activities and discussion to identify and analyze mentee competencies, gain hands-on experience plotting the competencies on the checklist, and brainstorm goal-setting using this helpful tool. Participants will also have opportunities to discuss characteristics of good mentors, examine honest and sensitive communication styles, and write personal action plans that increase professional therapy and mentoring skills. Home Supporting: Leaving the Toys in the Car Lyndsey Allen, LSLS Cert. AVT The Ear Foundation Jayne Simpson Allen, Dip.T., M.Ed., LSLS Cert. AVT Northern Cochlear Implant Programme Ellis is visited at home every week by his therapist who brings a box of fascinating toys and resources. After the therapist leaves, Ellis’ mom feels discouraged as she knows her son will not be interested in playing with her in the same way. Homes are rich in naturally occurring experiences that stimulate adult-child conversations without the need for store-bought toys. This workshop will include videos to build your confidence to support spoken language development using daily routines, photographs and books, and create meaningful and engaging playtime without conventional toys. Cheryl L. Dickson, M.Ed., LSLS Cert. AVT Auditory-Verbal Consultancy Helen M. Morrison, Ph.D., CCC-A, LSLS Cert. AVT Mary Boucher Jones, M.A., CCC-SLP, LSLS Cert. AVT Listen and Learn Auditory-Verbal Communication Center, Inc. This workshop is designed for LSLS certified professionals interested in developing or improving their skills as a mentor. When positive mentoring relationships are ListeningandSpokenLanguage.org/2014Convention • 202.337.5220 or 866.337.5220 5 2014 AG Bell Convention • June 26-30, 2014 • Walt Disney World Swan and Dolphin • Orlando, Florida GENERAL INFORMATION Hotel: The Walt Disney World Swan and Dolphin Resort Stay where the magic is happening! The Walt Disney World Swan and Dolphin Resort is ideally situated just moments away from the thrill and excitement of the Walt Disney World® theme parks. Reserve your room at the Walt Disney World Swan and Dolphin to save valuable time and expense. You will avoid the need to rent a car or spend up to two hours commuting back and forth to the convention from offsite hotels or locations. Visit swandolphin.com/groupres/agbell or call 1-800-227-1500 to join us and book your room at the Walt Disney World Swan and Dolphin. Mention “AG Bell” to get the convention rate of $169 per night. There is an additional resort service charge of $10 plus tax per night. The charge includes the following: • Unlimited domestic long distance and local calls • Unlimited access to the resort’s health club facilities • In room high-speed Internet access • 2 bottles of water daily Reservation requests for AG Bell will be accepted through Thursday, June 5, 2014. Requests received after this date are on a space availability basis. As an AG Bell Convention attendee and guest of the Swan and Dolphin Resort, you will have exclusive access to: • Extra Magic Hours—Enjoy extra time at select Disney theme park attractions as a guest of the Swan and Dolphin Resort. Lines for the most popular attractions are drastically shorter! • Complimentary scheduled transportation to all Walt Disney World® theme parks, attractions, Downtown Disney and Disney resorts • 20 percent discount on grab-and-go meal options • Two onsite Disney ticket desks • Priority seating at selected Disney restaurants throughout the Vacation Kingdom • Character dining • Advanced tee times on four championship Walt Disney World golf courses • Complimentary delivery of purchases made in Disney theme parks 6 All attendees of the 2014 AG Bell Convention agree to comply with all the rules and conditions of the convention, as found at ListeningandSpokenLanguage.org/ ConventionRegistration, all future correspondence, and as may be posted at the convention. certification. Pre-approved CEUs are applicable to continuing education credits for recertification as well as for professionals seeking LSLS certification. ASHA Transportation All convention attendees are eligible to receive $8 off roundtrip shared ride shuttle service from and to the airport courtesy of SuperShuttle Orlando using discount code AG14. Discounted rates are $18 one way and $32 roundtrip per person. Exclusive Sedans, SUVs, and Vans are available (rates vary). To book your transportation from/to the airport, please call SuperShuttle directly at 1-800-258-3826 or refer to ListeningandSpokenLanguage.org/ 2014Convention to book online. CEUs will be available from the American Speech-Language-Hearing Association (ASHA). For information on speaker disclosures, visit ListeningandSpokenLanguage.org/ PresenterBios. AAA Communication Access All pre-convention workshops and convention educational sessions will be real-time captioned. Oral, Cued Speech and ASL interpreting services will be provided upon request and as resources are available. The deadline for requests is May 14, 2014. Please indicate your preference when you register: ASL interpreter, oral interpreter or cued speech transliterator. CEUs and Certificates The 2014 AG Bell Convention is provided, in part, to assist professionals in their continuing education. The Convention and Pre-Convention Workshops will give professionals the opportunity to earn continuing education units (CEUs) from the AG Bell Academy for Listening and Spoken Language. CEUs will be available from the American Speech-Language-Hearing Association (ASHA). CEU approval is pending from the American Academy of Audiology (AAA). AG Bell Academy for Listening and Spoken Language AG Bell is pre-approved by the AG Bell Academy for Listening and Spoken Language to offer CEUs for Listening and Spoken Language Specialist (LSLS®) AG Bell is pending approval by the American Academy of Audiology (AAA) to offer Academy CEUs. AAA approval of this continuing education activity does not imply endorsement of course content, specific products or clinical procedures. Certificates of Learning AG Bell is pleased to offer documentation for educators or others who require it for state certification/ licensure. Teachers, please be sure to check with your local/state certifying body to determine whether or not the hours that you earn at Convention will be accepted for your licensure. General certificates of attendance will not be issued. More specific information about continuing education registration and the number of approved hours will be available in the final Convention Program, onsite at Convention, and on the Convention app. Attendees must indicate each organization for which they will need CEU verification on their registration form. Please indicate all of the certificates you require on your registration form and submit your CEU documents prior to departure. A certificate verifying the CEUs earned/instructional hours attended for each organization requested will be provided following the convention and filed with the organization on your behalf. ListeningandSpokenLanguage.org/2014Convention • 202.337.5220 or 866.337.5220 2014 AG Bell Convention • June 26-30, 2014 • Walt Disney World Swan and Dolphin • Orlando, Florida 2014 2014 AG AG Bell Bell Convention Convention 2014 AG Bell Convention June June 26–30, 26–30, 2014 2014 Walt Disney Disney World World Swan Swan and and Dolphin Dolphin •• Orlando, Orlando, Florida Florida ••Walt June 26–30, 2014 • Walt Disney World Swan and Dolphin • Orlando, Florida Children’s Program Registration Form Children’s Children’s Program Program Registration Registration Form Form Children’s Program Registration Form Important: Important:Only Onlyaaparent parentor orlegal legalguardian guardianmay mayregister registeraachild childfor forthis thisprogram. program.Registrations Registrationswill willbe beaccepted acceptedon onaa Important: Only a parent or until legal guardian may a child for this program. closes Registrations will accepted on a first-come, first-come,first-served first-served basis basis untilthe theprogram program isisregister full fullor oruntil until program program registration registration closeson onMay May 15, 15,be 2014. 2014. Additional Additional first-come, first-served basis until the program is full or until program registration closes on May 15, 2014. Additional information informationfor forand andabout aboutthe theprogram programwill willbe besent sentto toyou youwithin withinaafew fewweeks weeksof ofyour yourregistration registrationconfirmation. confirmation. information for and about the program will be sent to you within a few weeks of your registration confirmation. 1. 1. Parent/Legal Parent/Legal Guardian Guardian Information Information 1. Parent/Legal Guardian Information STREET STREETADDRESS ADDRESS STREET ADDRESS CITY CITY CITY STATE/PROVINCE STATE/PROVINCE STATE/PROVINCE COUNTRY COUNTRY COUNTRY EMAIL EMAILADDRESS ADDRESS EMAIL ADDRESS DAYTIME DAYTIMEPHONE PHONE DAYTIME PHONE DAYTIME DAYTIMEFAX FAX DAYTIME FAX ZIP/POSTAL ZIP/POSTALCODE CODE ZIP/POSTAL CODE CREDIT CREDITCARD CARDNUMBER NUMBER CREDIT CARD NUMBER EXP. EXP.DATE DATE EXP. DATE SECURITY SECURITYCODE CODE SECURITY CODE NAME NAMEAS ASIT ITAPPEARS APPEARSON ONTHE THECARD CARD NAME AS IT APPEARS ON THE CARD BILLING BILLINGSTREET STREETADDRESS ADDRESS BILLING STREET ADDRESS 2. 2. Child Child Information Information 2. Child Information Child Child#1 #1 Child #1 CITY CITY CITY FIRST FIRSTNAME NAMEOR ORNICKNAME NICKNAMEFOR FORBADGE BADGE FIRST NAME OR NICKNAME FOR BADGE DATE DATEOF OFBIRTH BIRTH CURRENT CURRENTAGE AGE CURRENT CURRENTGRADE GRADEIN INSCHOOL SCHOOL DATE OF BIRTH CURRENT AGE CURRENT GRADE IN SCHOOL HEARING HEARINGSTATUS STATUS(please (pleaseselect selectone): one): HEARING HEARING HARD HARDOF OFHEARING HEARINGOR ORDEAF DEAF HEARING STATUS (please select one): HEARING HARD OF HEARING OR DEAF DIETARY DIETARYACCOMMODATIONS: ACCOMMODATIONS: NONE NONE VEGAN VEGAN GLUTEN GLUTENFREE FREE KOSHER KOSHER DIETARY ACCOMMODATIONS: NONE VEGAN GLUTEN FREE KOSHER PLEASE PLEASENOTE NOTEANY ANYSEVERE SEVEREFOOD FOODALLERGIES ALLERGIES PLEASE NOTE ANY SEVERE FOOD ALLERGIES INDICATE INDICATET-SHIRT T-SHIRTSIZE: SIZE: YOUTH YOUTHXS XS INDICATE T-SHIRT SIZE: YOUTH XS ADULT ADULTSS ADULT ADULTMM ADULT S ADULT M Please Pleaseenter enterthe thetotal totalcalculated calculatedamount amountfrom fromthe the“Total “TotalDue” Due” Please enter the total calculated amount from the “Total Due” section sectionbelow. below. Fees Fees are are payable payableinin U.S. U.S.dollars dollars only. only. Please Please section below. Fees are payable in U.S. dollars only. Please make makechecks checkspayable payableto: to:Alexander AlexanderGraham GrahamBell BellAssociation. Association. make checks payable to: Alexander Graham Bell Association. TOTAL TOTALAMOUNT AMOUNTENCLOSED: ENCLOSED:$$ TOTAL AMOUNT OR ORCHARGE CHARGE MY: MY:ENCLOSED: $ OR CHARGE MY: VISA VISA MASTERCARD MASTERCARD AMERICAN AMERICANEXPRESS EXPRESS DISCOVER VISA MASTERCARD AMERICAN EXPRESS PARENT/GUARDIAN PARENT/GUARDIANNAME NAME PARENT/GUARDIAN NAME FIRST FIRST&&LAST LASTNAME NAME FIRST & LAST NAME 4. 4. Payment Payment 4. Payment YOUTH YOUTHSS YOUTH S ADULT ADULTLL ADULT L YOUTH YOUTHMM YOUTH M ADULT ADULTXL XL ADULT XL YOUTH YOUTHLL YOUTH L OTHER OTHERKEY KEYINFORMATION INFORMATIONWE WESHOULD SHOULDKNOW KNOWABOUT ABOUTYOUR YOURCHILD? CHILD? OTHER KEY INFORMATION WE SHOULD KNOW ABOUT YOUR CHILD? Child Child#2 #2 Child #2 STATE STATE STATE ZIP ZIP ZIP CARDHOLDER’S CARDHOLDER’SSIGNATURE SIGNATURE CARDHOLDER’S IfIf you youdo donot notneed needSIGNATURE receive receiveaaconfirmation confirmationwithin within10 10business business If youplease do notcontact need receive a confirmation within business days, days, please contact AG AGBell Bell to toensure ensurethat that your your10 registration registration days, please contact AG Bell to that your registration was was received. received. Please Pleaserefer refer to tothe theensure Refund/Cancellation Refund/Cancellation Policy Policy was received. Please refer to thedeadlines. Refund/Cancellation Policy for for cancellation cancellation procedures procedures and and deadlines. for cancellation procedures and deadlines. Please Pleasefax faxor ormail mailcompleted completedregistration registrationform formwith withall allfees feesto: to: Please fax or mail completed registration form with all fees to: 2014 2014 AG AG Bell Bell Convention Convention 2014Box AG 17487 Bell Convention P.O. P.O. Box 17487 P.O. Box 17487 Baltimore, Baltimore, MD MD21297-1487 21297-1487 Baltimore, MD 21297-1487 Phone: Phone: 202-337-5220 202-337-5220 or or866-337-5220 866-337-5220 Phone: 202-337-5220 or 866-337-5220 Fax: Fax: 202-337-8314 202-337-8314 Fax: 202-337-8314 Email: Email: email@example.com firstname.lastname@example.org Email: email@example.com CHILDREN’S CHILDREN’SPROGRAM PROGRAMREGISTRATION REGISTRATIONINSTRUCTIONS INSTRUCTIONS CHILDREN’S PROGRAM REGISTRATION INSTRUCTIONS Full Fullinstructions instructions are areavailable available atatListeningandSpokenLanguage.org/2014Convention ListeningandSpokenLanguage.org/2014Convention FIRST FIRST&&LAST LASTNAME NAME FIRST & LAST NAME FIRST FIRSTNAME NAMEOR ORNICKNAME NICKNAMEFOR FORBADGE BADGE FIRST NAME OR NICKNAME FOR BADGE DATE DATEOF OFBIRTH BIRTH CURRENT CURRENTAGE AGE CURRENT CURRENTGRADE GRADEIN INSCHOOL SCHOOL DATE OF BIRTH CURRENT AGE CURRENT GRADE IN SCHOOL HEARING HEARINGSTATUS STATUS(please (pleaseselect selectone): one): HEARING HEARING HARD HARDOF OFHEARING HEARINGOR ORDEAF DEAF HEARING STATUS (please select one): HEARING HARD OF HEARING OR DEAF DIETARY DIETARYACCOMMODATIONS: ACCOMMODATIONS: NONE NONE VEGAN VEGAN GLUTEN GLUTENFREE FREE KOSHER KOSHER DIETARY ACCOMMODATIONS: NONE VEGAN GLUTEN FREE KOSHER PLEASE PLEASENOTE NOTEANY ANYSEVERE SEVEREFOOD FOODALLERGIES ALLERGIES PLEASE NOTE ANY SEVERE FOOD ALLERGIES INDICATE INDICATET-SHIRT T-SHIRTSIZE: SIZE: YOUTH YOUTHXS XS INDICATE T-SHIRT SIZE: YOUTH XS ADULT ADULTSS ADULT ADULTMM ADULT S ADULT M YOUTH YOUTHSS YOUTH S ADULT ADULTLL ADULT L YOUTH YOUTHMM YOUTH M ADULT ADULTXL XL ADULT XL YOUTH YOUTHLL YOUTH L Full instructions are available at ListeningandSpokenLanguage.org/2014Convention Pre-registrationisisrequired requiredfor forparticipation participationininthe theChildren’s Children’sProgram. Program.Program Program Pre-registration Pre-registration isMay required for participation in the Children’s Program. Program registration registration closes closesMay 15, 15,2014. 2014. Onsite Onsiteregistrations registrations will willnot not be beaccepted. accepted. registrationwill closes May 15, on 2014. Onsite registrations will not bethe accepted. Registrations Registrations willbe beaccepted accepted onaafirst-come, first-come, first-served first-servedbasis basis until until theprogram programisisfull. full. Registrations will be accepted on a first-come, first-served basis until the program is full. Pleaseprint print clearly typeall allinformation information when completing the registration form. Please clearly orortype when completing the registration form. Please print clearly or type all information whenincluding completing the registration form. information requested eachsection, section, includingpayment payment information. Complete Complete allall information requested inineach information. Complete all information requested in each section, including payment information. Illegibleororincomplete incompleteinformation informationwill willdelay delaythe theprocessing processingofofyour yourregistration. registration.IfIfyou you Illegible Illegible or incomplete information will delay the processing ofcontact your registration. have have questions questions about aboutany any part partofofthe the registration registration form, form,please please contact AG AGBell. Bell. If you have questions about any part of the registration form, please contact AG Bell. 1.1. PARENT PARENT GUARDIAN GUARDIAN INFORMATION INFORMATION 1. PARENT GUARDIAN INFORMATION Only Only aaparent parent ororlegal legalguardian guardian should shouldcomplete completethe theregistration registrationinformation. information.The The Only aorparent orguardian legal guardian should complete the registration information. The parent orlegal legalguardian shouldbe beonsite onsite dropthe thechild offand and pickthe thechild child up parent should totodrop childoff pick up parent orIflegal guardian should be onsite toonsite, drop the childcontact off andAG pick thebefore child up day. Ifthe theparent parentisisnot notplanning planning be onsite, please contact AGBell Bell before each eachday. totobe please each day. your Ifyour thechild. parent registering child. is not planning to be onsite, please contact AG Bell before registering registering your child. 2.2. CHILD CHILDINFORMATION INFORMATION 2. sure CHILD INFORMATION Be Be suretotoinclude includeall allinformation informationfor foreach eachchild childyou youare areregistering. registering.The Thefollowing following OTHER OTHERKEY KEYINFORMATION INFORMATIONWE WESHOULD SHOULDKNOW KNOWABOUT ABOUTYOUR YOURCHILD? CHILD? OTHER KEY INFORMATION WE SHOULD KNOW ABOUT YOUR CHILD? Be sure to include all information for each child you are registering. The following dietary dietary accommodations accommodations are areavailable: available: vegan, vegan, gluten gluten free free ororkosher. kosher.We Wecannot cannot dietary accommodations are available: vegan, including gluten free or kosher. cannot accommodate requestsbeyond beyond theseoptions, options, including requests forWe specific foods. accommodate requests these requests for specific foods. Child Child#3 #3 Child #3 accommodate requests beyond these options, requests for specific foods. IfIf the thechild’s child’sdietary dietary restrictions restrictions are are more more severe severeincluding ororrestrictive restrictive than thanthe theoptions optionslisted listed If the child’s dietary restrictions are more severe or restrictive than the options listed above, parents should plantotoprovide provide themeals mealsand and snacksrequired required by thechild. child. above, parents should plan the snacks by the FIRST FIRST&&LAST LASTNAME NAME FIRST & LAST NAME above, parents should plan to provide the meals and snacks required by the child. 3.3. REGISTRATION REGISTRATION FEE FEE 3. REGISTRATION FEE Indicate Indicate the thenumber numberofof registrations registrationsinineach eachage/price age/pricecategory categoryand andcalculate calculatethe thetotal. total. FIRST FIRSTNAME NAMEOR ORNICKNAME NICKNAMEFOR FORBADGE BADGE FIRST NAME OR NICKNAME FOR BADGE DATE DATEOF OFBIRTH BIRTH CURRENT CURRENTAGE AGE CURRENT CURRENTGRADE GRADEIN INSCHOOL SCHOOL DATE OF BIRTH CURRENT AGE CURRENT GRADE IN SCHOOL HEARING HEARINGSTATUS STATUS(please (pleaseselect selectone): one): HEARING HEARING HARD HARDOF OFHEARING HEARINGOR ORDEAF DEAF HEARING STATUS (please select one): HEARING HARD OF HEARING OR DEAF DIETARY DIETARYACCOMMODATIONS: ACCOMMODATIONS: NONE NONE VEGAN VEGAN GLUTEN GLUTENFREE FREE KOSHER KOSHER DIETARY ACCOMMODATIONS: NONE VEGAN GLUTEN FREE KOSHER PLEASE PLEASENOTE NOTEANY ANYSEVERE SEVEREFOOD FOODALLERGIES ALLERGIES PLEASE NOTE ANY SEVERE FOOD ALLERGIES INDICATE INDICATET-SHIRT T-SHIRTSIZE: SIZE: YOUTH YOUTHXS XS INDICATE T-SHIRT SIZE: YOUTH XS ADULT ADULTSS ADULT ADULTMM ADULT S ADULT M YOUTH YOUTHSS YOUTH S ADULT ADULTLL ADULT L YOUTH YOUTHMM YOUTH M ADULT ADULTXL XL ADULT XL YOUTH YOUTHLL YOUTH L only. Payment must be received with Registration Form in order for should the registration tration totobe beprocessed. processed. Payment Paymentalong for forany any other other AG AGBell Bellproduct product oror service service should tration totoAG be Payment for anyMake otherall AG Bell product orto: service should be besent sentto AGprocessed. Bell Bellunder underseparate separatecover. cover. Make all checks checks payable payable to: Alexander Alexander be sent Bell to AG Bell under separate cover. Make all checks payable to: Alexander Graham Graham Bell Association. Association. Graham Bell Association. Once Oncepayment payment has hasbeen beenprocessed, processed,registrants registrantswill willreceive receiveaaconfirmation confirmationvia viaemail. email. Once payment has been for processed, registrants will receive a confirmation via email. Please Please keep keep this thisconfirmation confirmation foryour yourrecords records as asno noadditional additional receipts receipts will willbe beissued. issued. Please keep this confirmation for your records as no additional receipts will be issued. Within Within aaweek week orortwo twoofofregistration, registration, parents parents will will receive receivean aninformation information packet packet Within a week ortoto two of registration, parents receive an information packet via viaemail email with with forms forms collect collect additional additionalrequired requiredwill information information such such as asmedical medical via email with forms to collect additional required information such asThe medical and andemergency emergency contact contact information, information, and andconsent consentand andwaivers waiversforms. forms. The packet packet clothing and supplies for the child(ren). 5.5. REFUNDS/CANCELLATIONS REFUNDS/CANCELLATIONS 5. REFUNDS/CANCELLATIONS Refunds Refunds for forthe theChildren’s Children’sProgram, Program,less lessaa$50 $50administrative administrativefee, fee,will willbe bemade madeonly onlyifif 3. 3. Registration Registration Fee Fee 3. Registration Fee RATE RATEFOR FORCHILDREN CHILDRENAGES AGESBIRTH BIRTHTHROUGH THROUGH47 47MONTHS: MONTHS: RATE FOR CHILDREN AGES BIRTH THROUGH 47 MONTHS: RATE RATEFOR FORCHILDREN CHILDRENAGES AGES44THROUGH THROUGH14: 14: RATE FOR CHILDREN AGES 4 THROUGH 14: PleaseChildren’s enter the Program total calculated amount from all entries above. Payment reflect reflect Children’s Program registration registration only. only. Payment Payment may may be bemade made ininU.S. U.S.should dollars dollars reflect Children’s Program registration only. Payment may be in made infor U.S. dollars only. only. Payment Payment must must be bereceived received along alongwith with Registration Registration Form Form inorder order forthe the regisregis- and emergency contact information, and consent and waivers The packet will will also also include includeinformation information on onthe theprogram’s program’s schedules schedules as aswell wellforms. as asrecommended recommended will alsoand include information on the program’s schedules as well as recommended clothing clothing andsupplies supplies for forthe thechild(ren). child(ren). OTHER OTHERKEY KEYINFORMATION INFORMATIONWE WESHOULD SHOULDKNOW KNOWABOUT ABOUTYOUR YOURCHILD? CHILD? OTHER KEY INFORMATION WE SHOULD KNOW ABOUT YOUR CHILD? PRICE PRICE PRICE $275 $275 $275 $395 $395 $395 the number of registrations in each age/price category and calculate the total. 4.Indicate 4.PAYMENT PAYMENT 4. PAYMENT Please Please enter enterthe thetotal totalcalculated calculatedamount amountfrom fromall allentries entriesabove. above.Payment Paymentshould should xx x xx x xx x QUANTITY QUANTITY QUANTITY ==TOTAL TOTAL = TOTAL ==$$ =$ ==$$ =$ TOTAL TOTALDUE: DUE:==$$ TOTAL DUE: = $ Refunds for theisChildren’s less a $50 administrative fee,No will be made only the thecancellation cancellation isreceived receivedProgram, ininwriting writingby byThursday, Thursday, June June5,5,2014. 2014. Norefunds refunds will will be beif the cancellation is received in writing Thursday, June 5, 2014. Nodue refunds will be issued issued for forcancellations cancellations received received after afterby this this date; date;this thisincludes includes refunds refunds duetotoillness, illness, issued for weather cancellations received afterother this date; this includesCredit refunds due to illness, late late arrival, arrival, weatherconditions conditions and/or and/or other travel travel difficulties. difficulties. Creditbalances balances and/or and/or late arrival,refund weather conditions and/or other travel difficulties. Credit balances and/or un-cashed refundchecks checks maynot not beused used purchase un-cashed may be toto purchase additional additional items items onsite. onsite. un-cashed refund checks may not be used to purchase additional items onsite. Questions? Questions?Call Callus usatat202-337-5220 202-337-5220ororemail emailus firstname.lastname@example.org email@example.com. Questions? Call us at 202-337-5220 or email us at firstname.lastname@example.org ListeningandSpokenLanguage.org/2014Convention • 202.337.5220 or 866.337.5220 7 2014 AG Bell Convention • June 26-30, 2014 • Walt Disney World Swan and Dolphin • Orlando, Florida SOURCE CODE 2014 AG Bell Convention June 26–30, 2014 • Walt Disney World Swan and Dolphin • Orlando, Florida SOURCE CODE _________________ 2014 AG Bell Convention Registration Form 2014 AG Bell Convention Registration Form 1. Badge Information Please print my badge to read: FIRST NAME LAST NAME BADGE NAME STATE/PROVINCE COUNTRY COMPANY/ORGANIZATION CITY PARENT/FAMILY PROFESSIONAL DEAF/HARD OF HEARING ADULT OTHER Please print my spouse or family member’s badge to read: FIRST NAME LAST NAME BADGE NAME CITY STATE/PROVINCE COUNTRY 2. Mailing Address STREET ADDRESS CITY STATE/PROVINCE ZIP/POSTAL CODE EMAIL ADDRESS (REQUIRED FOR CONFIRMATION) COUNTRY DAYTIME PHONE DAYTIME FAX THIS WILL BE MY/OUR FIRST AG BELL CONVENTION AG Bell exhibitors and registrants may receive your mailing address in advance of the convention. CHECK HERE IF YOU DO NOT WANT EXHIBITOR-RELATED MAILINGS. CHECK HERE IF YOU DO NOT WANT YOUR NAME INCLUDED ON THE SHARED ATTENDEE LIST. 3. Communication Access All convention educational sessions and pre-convention workshops will be real-time captioned. Oral, Cued Speech and ASL interpreting services will be provided upon request and as resources are available. Deadline for requests is May 14, 2014. Please indicate your preference below: ASL INTERPRETER ORAL INTERPRETER CUED SPEECH TRANSLITERATOR 4. Dietary Restrictions GLUTEN FREE VEGETARIAN KOSHER OTHER* * Please contact AG Bell at email@example.com no later than June 4, 2014 to specify. 5. Registration Fees Early Bird ends April 16 | Regular April 17– June 16 Professional AG Bell Member (includes CEUs) EARLY BIRD $350 REGULAR $400 ONSITE $450 Professional Non-member (includes CEUs and 1 year professional membership) EARLY BIRD $430 REGULAR $480 EARLY BIRD $300 REGULAR $350 ONSITE $400 Non-professional Non-member (includes up to two badges per registration) EARLY BIRD $350 REGULAR $400 One-Day (select a day) $200 SATURDAY Teen Pass (ages 15–17 years) $50 SUNDAY ONSITE $530 Non-professional Member (includes up to two badges per registration) Student (18 years and up) $200 ONSITE $450 CEUs (No additional charge; you must complete this section to receive CEUs) AG BELL ACADEMY ASHA AAA CERTIFICATE OF LEARNING For information about CEUs, visit ListeningandSpokenLanguage.org/2014ConventionCEUs/ PROFESSIONAL GROUP DISCOUNT = 10% OFF FOR GROUPS OF FIVE OR MORE (please contact firstname.lastname@example.org to complete your registration) 8 ListeningandSpokenLanguage.org/2014Convention • 202.337.5220 or 866.337.5220 2014 AG Bell Convention • June 26-30, 2014 • Walt Disney World Swan and Dolphin • Orlando, Florida ListeningandSpokenLanguage.org/2014Convention 6. Pre-Convention Workshops 8. Payment YOU ARE RESPONSIBLE FOR ANY SCHEDULING CONFLICTS. PLEASE FILL OUT THIS SECTION CAREFULLY. PRE-CONVENTION WORKSHOPS ARE $85 PER SESSION. Please enter the total calculated amount from all of the above entries. Fees are payable in U.S. dollars only. Please make checks payable to: Alexander Graham Bell Association. Thursday, June 26, 8:00 a.m.–11:30 a.m. TOTAL AMOUNT ENCLOSED: $ OR CHARGE MY: VISA MASTERCARD AMERICAN EXPRESS DISCOVER BRIDGING GAPS: CONTINUOUS LEARNING MODEL TOMORROW’S MAGIC, TODAY’S LEARNING IT’S NOT FINE. IT’S NOT OK Thursday, June 26, 1:00 p.m. –4:30 p.m. REAL-TIME EMBEDDED COACHING DETERMINING ELIGIBILITY THEORY OF MIND & PRAGMATICS CREDIT CARD NUMBER EXP. DATE SECURITY CODE NAME AS IT APPEARS ON THE CARD Friday, June 27, 8:00 a.m. –11:30 a.m. FACILITATING CHANGE/MOTIVATIONAL INTERVIEWING HANDS-ON: APPS AND THE IPAD TRANSFORMING THE FUTURE THROUGH MENTORING HOME SUPPORT: LEAVE THE TOYS IN THE CAR BILLING STREET ADDRESS CITY PRICE QUANTITY $85 x TOTAL = PRICE QUANTITY TOTAL $0 x = $25 x = STATE ZIP CARDHOLDER’S SIGNATURE 7. Other Events Dena Goldstein Mixer (RSVP required) FRIDAY, JUNE 27 3:00 p.m.–4:30 p.m. Four Ways to Register! LOFT Reunion Lunch SATURDAY, JUNE 28 12:00 p.m.–1:30 p.m. Happy Hour • Online at ListeningandSpokenLanguage.org/2014Convention • Fax completed registration form and payment to 202-337-8314 • Mail registration form to AG Bell at 2014 AG Bell Convention, P.O. Box 17487, Baltimore, MD 21297-1487 • Email completed registration form to email@example.com All registrations must be received by June 16, 2014. SATURDAY, JUNE 28 6:00 p.m. –7:30 p.m. (includes one drink ticket, light refreshments) Payment information must be included in order for your registration to be processed. $25 x = Club Volta ListeningandSpokenLanguage.org/2014Convention SATURDAY, JUNE 28 8:30 p.m.–10:30 p.m. (includes one drink ticket, refreshments and activities) REGISTRANTS NON-REGISTRANTS $35 $50 x x = = Breakfast with Friends SUNDAY, JUNE 29 7:30 a.m. –9:00 a.m. Cut-off date for registration is June 5. ADULT CHILD AGE 3–9 CHILD UNDER 3 $20 $10 FREE x x x = = = REFUNDS/CANCELLATIONS Refunds for Convention registration fees, pre-convention workshops and ticketed events, less a $50 administrative fee, will be made only if cancellation is received in writing by Thursday, June 5, 2014. No refunds will be issued for cancellations received after this date; this includes refunds due to illness, late arrival, weather conditions and/or other travel difficulties. Credit balances and/or un-cashed refund checks may not be used to purchase additional items onsite. IF YOU HAVE ANY QUESTIONS, please feel free to give us a call at 202-337-5220 or 866-337-5220. ListeningandSpokenLanguage.org/2014Convention • 202.337.5220 or 866.337.5220 9 3417 Volta Place, NW • Washington, DC 20007 Be a part of the largest gathering of families, professionals and adults with hearing loss dedicated to a listening and spoken language outcome. Earn up to 22.5 CEUs included with registration fees—an excellent professional development value! Enjoy the most magical place on earth—perfect for a family vacation. WHO SHOULD ATTEND: • Families raising children with hearing loss • Adults who are deaf and hard of hearing • Listening and Spoken Language Specialists • Teachers of the deaf • Speech-language pathologists • Audiologists • Students in speech-language pathology, audiology and deaf education