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ALDAcon 2016 Online Registration
*First Name:
Nickname for ID badge:
(if different from first name)
*Last Name
*Address:
Address #2
*City:
State:
Choose a State
None
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip:
*Country:
*Phone#:
*Phone Type
Voice
Cell
Text
CapTel
VP
*Email Address:
Valid email is required
*I am a member of ALDA (Chapter/Group or none)
*Hearing Status:
Late-Deafened
Hearing
Hard-of-Hearing
Born Deaf
I am Personal Care Attendant
free reg; must purchase meals
This is my First ALDAcon
Hearing / Service Dog: You MUST indicate here if you are bringing a hearing/service dog.
(Dog must stay on leash.)
**Join or Renew ALDA Membership
Choose Membership
Regular Membership (Under 62) $30.00
Senior (62 or better) $25.00
Business Membership $50.00
Veteran Membership $25.00
Lifetime Bronze Membership $500.00
Lifetime Silver Membership $1500.00
Lifetime Gold Membership $3000.00
My Membership is Current $00.00
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Membership in ALDA Inc. is NOT the same as an ALDA chapter/group membership.
You must be a member of ALDA Inc. to obtain the member rate for the convention.
New or Renew
New
Renew
Neither
*Full Registration prices include workshops, exhibits, entertainment, & speakers.
The following are also included in full Registration Fee:
* Wednesday Welcome Reception
* Thursday President`s Luncheon
* Friday Appreciation Luncheon
* Friday I. King Jordan Award Banquet
* Saturday Inspiration Luncheon
* Saturday Karaoke Party
* Sunday Farewell Brunch
ALDA Member
Registration Type:
Choose Type
Early Bird - Until 6/30/16 $275.00
Regular - 7/1/16 - 8/31/16 (Online Registration closed 8/31 $315.00
Tortoise - From 9/1/16 and after - Onsite registration only $340.00
Non-Member
Registration Type:
Choose Type
Early Bird Until 6/30/16 $305.00
Regular 7/1/16 - 8/31/16 (Online Registration Closed 8/31 $345.00
Tortoise From 9/1/16 Onsite registration only. $370.00
Veteran
Registration Type:
Choose Type
Early Bird Until 8/31/2015 (Online Registration Closed 8/31 $255.00
Tortoise - From 9/1/16 - Onsite Registration Only. $320.00
Spouse / SO: limited to one companion per Full Registration
Registration Type:
Choose Type
Early Bird Until 6/30/16 $255.00
Regular 7/1/16 - 8/31/16 (Online Registration Closed 8/31 $295.00
Tortoise - From 9/1/16 Onsite Registration only $320.00
Single Day Registration
Single Days Registration
Choose Item
One Day - $70.00
Two Days $130.00
Three Days $190.00
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Day(s) Selected
Select
Day(s) Selected
Thursday
Friday
Saturday
Thursday/Friday
Friday/Saturday
Thursday/Friday/Saturday
- One, Two, or Three-day registrations include meals (except for the I. King Jordan Banquet and the Saturday Karaoke)
A LA CARTE Meals/Events
Specify number of tickets for each ADDITIONAL meal or event:
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Thursday President`s Luncheon
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Friday Appreciation Luncheon
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+
Friday I.King Jordan Awards Banquet
Qty
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+
Saturday Inspiration Luncheon
Qty
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+
Saturday Karaoke Party
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Sunday Farewell Brunch
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Tax Deductible Donation
Tax-Deductible Donation
GRAND TOTAL:
Special Needs
Dietary needs are:
Allergies:
"ADA room kits" needed:
Mobility accessible room needed:
Any other needs:
All workshops / events will feature sign language interpreters and CART (Communication Access Realtime Translation). Workshop rooms will be looped to assist those with T-coils.
I would like help with a Roommate
Yes
No
I am a:
Female
Male
Additional Information
By checking YES above, I agree to allow the ALDAcon Roommate Coordinator to share my Information via email with any ALDA attendee of the same gender. Also, I agree to coordinate with my potential roommate to determine if we are a match. We will discuss items such as service animals, allergies, smoking, etc. We will then notify the Roommate coordinator by email of our decision after determining if we agree to room together & share expenses. NOTE: All room reservations are the responsibility of the agreed-upon roommates.
Refund Policy for Registrations
Requests for refunds (minus $50.00 handling and processing fee) will be honored until July 31, 2016. 6
NO refunds will be given after August 1, 2016. Contact ALDAcon 2016 co-planning chair, Jane Schlau at Janeila@nac.com for consideration of unique circumstances, such as illness or a death in the family and for registration transfer information.
EZ Pay Plan
If you wish to make payments toward your registration and/or hotel costs, please use the fields below, instead of the (ALDA Member, Non-Member, Veteran, etc.) fields above. Total registration must be received by August 1st using this multiple payment plan. Minimum payment Of $50. to start, any increment afterwards. This locks in the Early Bird rate, as long as you start before the Early Bird deadline.
Indicate Registration or Hotel
Indicate Registration or Hotel
METHOD OF PAYMENT
*Payment Method
Pay online with Credit Card using PayPal ** No PayPal account needed *
Print and Mail with Check or Money Order
Print and Mail - For manual CC process
Reserve Your Hotel Room TODAY!
Reserve Your Room at the Sheraton Milwaukee Brookfield Hotel TODAY!
The ALDAcon room rate of $116.00 + taxes ends Sept. 2nd.
Sheraton Milwaukee Brookfield Phone number is: (262)364-1100
Hotel reservations may be made online at the following link:
           Â
ALDA 2016 Convention        Â
Mailing Address
Mail Check or Credit card info to:
ALDAcon 2016 Registration
c/o Karen Krull
7815 S Central
Burbank, IL 60459 USA
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