4 Easy Ways to
Register!
1. By Mail:
Fill out and print this Form (see below) and
mail the complete form to:
TDI - 2005 Conference
8630 Fenton Street, Suite 604
Silver Spring, Maryland 20910-3803
2. By Fax:
Fax this form to TDI at: 301-589-3797
3. By Phone:
Call TDI: 301-589-3006 TTY
301-589-3786 Voice
4. By Internet:
Click here
and register for the Conference online!
Note: Confirmation
letters will be sent within four weeks after receipt of registration.
Please contact the office after four weeks if you do not receive
confirmation. Unconfirmed registrations cannot be guaranteed.
Important: In
order to enjoy member rates for the Conference, you must
be a current TDI member and are attending the Conference on your own.
To join TDI, see the online
membership application. If you attend as a representative of
a company or an agency, you pay company or organization rates.
Name: ___________________________________________________
Spouse: __________________________________________________
Company/Organization: ______________________________________
Name for Badge: ___________________________________________
Street Address: ____________________________________________
City: ______________________ State: ___________ Zip: __________
Home Phone: _______________ TTY
Voice Both
Work Phone: _______________ TTY
Voice Both
Fax: ________________
Email address: _____________________________________________
Emergency Contact Name: ___________________________________
Phone: (____) ________________ TTY
Voice Both
Special Accommodations Needed (check all that apply):
CART
Sign Language
Voice Interpreting
Tactile Interpreting
ALD
Other: _____________________
2005 TDI Conference Registration Fees:
Registration for Companies/Organizations
3-Day Registration*:
$350 x ____ = $______
One-Day Registration*:
$200 x ____ = $______
President’s Reception: $
40 x ____ = $______
Special
Luncheon:
$ 45 x ____ = $______
Awards
Luncheon:
$ 45 x ____ = $______
Total: $______
Special Combo Price**:
$425 x ____ = $______
Registration for Individual Members
3-Day Registration*:
$100 x ____ = $______
One-Day Registration*:
$ 50 x ____ = $______
President’s Reception: $ 40 x
____ = $______
Special
Luncheon:
$ 45 x ____ = $______
Awards
Luncheon:
$ 45 x ____ = $______
Total: $______
Special Combo Price**:
$200 x ____ = $______
TDI Member Combo Price**:
(if paid by 4/30/05)
$180 x ____ = $______
* Registration
includes name tag, program book,
and admission to workshops and exhibits.
** Includes registration and all
the three events mentioned above
Payment Method
Pay by check/money order
Pay by credit card, information enclosed below:
American
Express
VISA
MasterCard
Card No.
___________________________________
Expiration Date:
___________
Print Name of Cardholder:
________________________________
Cardholder’s Signature:
__________________________________
Please print out this
form and once completed, mail or fax to TDI.
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© Copyright 2005 TDI
