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THE SUMMER INSTITUTE ON NEURODEVELOPMENTAL DISORDERS ACROSS THE LIFESPAN: RESEARCH TO PRACTICE JOINTLY SPONSORED BY: UC DAVIS HEALTH SYSTEM OFFICE OF CONTINUING MEDICAL EDUCATION CENTER FOR EXCELLENCE IN DEVELOPMENTAL DISABILITIES AT THE MIND INSTITUTE AND SACRAMENTO STATE UNIVERSITY FRIDAY AUGUST 5, 2011 PLUS PRE-CONFERENCE WORKSHOP THURSDAY, AUGUST 4, 2011 LOCATION: UNIVERSITY UNION BALLROOM SACRAMENTO STATE UNIVERSITY SACRAMENTO, CALIFORNIA

ON NEURODEVELOPMENTAL DISORDERS ACROSS THE LIFESPAN ... 2011 brochure final.pdf · vances in research on neurodevelopmental disorders and the implications for best practices in prevention,

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THE SUMMER INSTITUTEON NEURODEVELOPMENTAL DISORDERS ACROSS THE LIFESPAN: RESEARCH TO PRACTICE

JOINTLY SPONSORED BY:UC DAVIS HEALTH SYSTEMOFFICE OF CONTINUING MEDICAL EDUCATIONCENTER FOR EXCELLENCE IN DEVELOPMENTAL DISABILITIES AT THE MIND INSTITUTEANDSACRAMENTO STATE UNIVERSITY

FRIDAYAUGUST 5, 2011

PLUSPRE-CONFERENCE WORKSHOPTHURSDAY,AUGUST 4, 2011

LOCATION:UNIVERSITY UNION BALLROOMSACRAMENTO STATE UNIVERSITYSACRAMENTO, CALIFORNIA

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9:45 – 10:15 B R E A K A N D M O V E I N T O W O R K S H O P S

7:30 – 8:30 am Registration, continental breakfast, visit exhibits

8:30 – 8:45 Welcome and Review of ObjectivesRobin Hansen, Director, Center for Excellence in Developmental Disabilities (CEDD), MIND Institute

8:45 – 9:45 Keynote Address Louis Vismara, M.D. and Laurie Vismara, Ph.D., BCBA-D

Autism Research and Policy: A Family Journey One family’s story: The importance of family advocacy in advancing research and public policy

2:15 - 2:30 B R E A K A N D M O V E I N T O W O R K S H O P S

11:45 - 12:45 L U N C H ( I N C L U D E D I N T U I T I O N )

4:00 - 4:15 B R E A K A N D M O V E I N T O S E S S I O N S

C O N C U R R E N T W O R K S H O P S

C O N C U R R E N T W O R K S H O P S

C O N C U R R E N T S E S S I O N S

C O N C U R R E N T W O R K S H O P S

THE SUMMER INSTITUTE ON NEURODEVELOPMENTAL DISORDERSFRIDAY, AUGUST 5, 2011

1 Neurological Basis forLearning Disabilities: Implications for Educational Practice

Barbara Glaeser, Ph.D. and Debra Cote, Ph.D.

An educator’s perspective on the neurology of learning disabilities and translation into evidence-based classroom practices

9 Tap into the Potential of theMulti-Touch Interface

Shane Nurnberg

Overview and demonstration of applications available for iPad/iPhone/iPod and other touch products and how they can help people with disabilities

2 End-of-Life Planning: Education, Advocacy, and Decision-Making

Mark Starford

Planning tools related to person-centered end-of-life planning for children, youth, and adults

5 First Signs of Autism: Rethinking Onset Sally Ozonoff, Ph.D.

Overview of developmental trajectories, onset, and regression in autism, and identification of autism in infants

14 Ask Me Session: Multi-Touch Technology For questions related to applications

for iPad/iPhone/iPod and other touch products

10 Scaling Up Positive Behavior Support for Secondary School Students with Disabilities

Lucas Anderson, Ed.S., Jeff Kramer, and Erin Chargin

Understanding the role of contextual fit in the development of behavior support plans that engage students, families, and school personnel

3 Enhancing Students’ Self-Regulation with Technologically Assisted Interventions

Ingrid Leckliter, Ph.D.

Understanding and promoting self-regulation and adaptive function using evidence-based, computer-assisted interventions

4 Environmental Contributors to Autism Spectrum Disorders

Isaac Pessah, Ph.D.

An overview of the developmental neurotoxicity of common chemicals, genetic variation in chemical sensitivity, and gene-environment interactions

6 Dual Diagnoses in Children with Developmental Disorders: Evaluation, Early Diagnosis, and Intervention

Sufen Chiu, M.D., Ph.D., Khyati Brahmbhatt, M.D., and Elizabeth Gutierrez, M.D.

Assessment and management of children with developmental disabilities presenting with psychiatric symptoms

8 Understanding Parents of Teen and Adult Children with Disabilities: Supporting Vulnerable Relationships

Lucia Milburn, Ph.D.

Understanding positive and negative impacts of professional interventions on parent-child relationships

7 Social Emotional Learning:A Key to Friendships

Meryl Lipton, M.D., Ph.D.

Assessment and intervention strategies for children with social emotional learning difficulties

15 Ask Me Session: Advocacy and Family Support For questions related to the impact of having a child

with developmental disabilities and support for individuals with disabilities and their families

11 The Genetics and Metabolic Evaluation of Children with Developmental Delay

Billur Moghaddam, M.D.

Considerations for evaluation and family counseling

12 Lost in Translation: Cross Cultural Communication Strategies

Eun Mi Cho, Ed.D., Sergio Aguilar-Gaxiola, M.D., Ph.D., Diana Rudametkin de Aguilar

Understanding underlying factors that can influence the cross-cultural communication and interpretation process in educational and medical settings

STRANDS:Advocacy and Family Support: 1 or 2, 8, 12, 15

Interventions: 3, 7, 9 or 10, 14

Neurodevelopmental Disorders (NDD): 4, 5 or 6, 11, 13

The “Ask Me” sessions provide an opportunity for participants to ask follow-up questions to presenters and to family members of people with disabilities.

13 Ask Me Session: Neurodevelopmental Disorders For questions related to research and

standards for best practices in autism and other neurodevelopmental disorders

5:00 A D J O U R N , T U R N I N E V A L U A T I O N S , P I C K U P C E R T I F I C A T E O F A T T E N D A N C E

TARGET AUDIENCEThis course is designed for healthcare professionals, educators, therapists, and families/caregivers, including physicians, nurses, nurse practitioners, physician assistants, psychologists, occupational therapists, speech and language pathol-ogists, licensed clinical social workers, and marriage and family therapists.

COURSE OBJECTIVESAt the end of the program, participants should be able to:

• Interpret information on how to integrate as-sessment with ongoing treatment of individu-als with neurodevelopmental disorders in or-der to implement more effective intervention

• Recognize the challenges families face when dealing with the evaluation and treatment of a child with a developmental disability

• Indentify procedures and tools available for use in early identification of autism in order to facilitate more effective management by primary care providers

• Explain how to integrate assessment with ongoing treatment of individuals with neurodevelopmental disorders in order to implement more effective intervention

• Define the challenges families face when deal-ing with the evaluation and treatment of a child with a developmental disability

• State procedures and tools available for use in early identification of autism in order to facili-tate more effective management by primary care providers

• Evaluate a child with developmental disabili-ties for psychiatric disorders

• Identify the special needs of adolescents and

adults in transitioning to the world of work and community life in order to devote more time and attention in assisting this population

• List the developmental neurotoxicity of com-mon chemicals

• Use computer-assisted interventions that sup-port self-regulation and adaptive function

• Apply cross-cultural communication strate-gies in translation and interpretation to im-prove quality of education and care

• Justify person-centered strategies for end-of-life decision-making practices, with emphasis on the special needs of people with developmental disabilities

NEEDS ASSESSMENTThis conference is intended to help participants keep pace with the latest ad-vances in research on neurodevelopmental disorders and the implications for best practices in prevention, assessment and treatment. The focus is interdis-ciplinary and across the lifespan. Based on evaluations from last year’s confer-ence, special attention is paid to dual diagnoses, advocacy and family support, and cross-cultural communication.

CALIFORNIA AB 1195With the passage of California Assembly Bill 1195, signed November 2005, continuing medical education courses with patient care components are required to include curricula in the subject of cultural and linguistic competency. It is the intent of the bill, which went into effect on July 1, 2006, to encourage physicians and surgeons, CME providers in the state of California, and the Accreditation Council for Continuing Medical Education to meet the cultural and linguistic concerns of a diverse patient population through appropriate professional development. The planners, speakers, and authors of this CME activity have been encouraged to address issues relevant in their topic area. In addition, a variety of resources are available to address cultural and linguistic competency, some of which will be included in the syllabus or handout materials. Additional resources and information about CA AB 1195 can be found on our website at http://cme.ucdavis.edu.

PRE-CONFERENCE WORKSHOPSELF-ADVOCACY: GIVING PERSONS WITH DISABILITIES A VOICEDATE & TIME: Thursday, Aug 4, 1:00-5:00LOCATION: UC Davis MIND Institute, 2825 50th Street, Sacramento, CA

Self-Advocacy is a critical skill for adolescents and adults with disabilities. This workshop will cover the history and relevance of self-advocacy and self-determination and the importance of self-advocacy for the educational, occupational, and social success of persons with disabilities. Participants will learn and practice the Self-Advocacy Strategy, designed to teach youth and adults with disabilities to actively participate in discussing their educational and occupational future.

The session will be conducted by Barbara Glaeser, Ph.D., and Debra Cote, Ph.D., Professors of Special Education at California State University Fullerton. The cost of the workshop is $85 per person, which includes a copy of “The Self-Advocacy Strategy Manual” (book and DVD). Last day to register is Monday, July 18. To register, please contact Sharon Fallis at [email protected].

PRE-CONFERENCE WORKSHOP

WORKSHOP REQUIRES SEPARATE ENROLLMENT

Billur Moghaddam, M.D. Clinical Director, Division of Genetics UC Davis MIND Institute

Sally J. Ozonoff, Ph.D. Professor, Department of Psychiatry and Behavioral Sciences UC Davis MIND Institute

Isaac Pessah, Ph.D. Professor and Chair School of Veterinary Medicine / Molecular Biosciences UC Davis MIND Institute

Diana Rudametkin de Aguilar UC Davis Medical Interpreting Services

Laurie A. Vismara, Ph.D., BCBA-D Assistant Research Scientist, Department of Psychiatry and Behavioral Sciences UC Davis MIND Institute

COURSE CHAIR PLANNING COMMITTEE

GUEST FACULTY

UC DAVIS FACULTY

FACULTY

SACRAMENTO STATE UNIVERSITY FACULTY

Lucas Anderson, Ed.S Behavior Specialist San Juan Unified School District

Erin Chargin CEO, Learning Solutions

Debra Cote, Ph.D. Assistant Professor of Special Education California State University, Fullerton

Barbara Glaeser, Ph.D. Professor of Special Education California State University, Fullerton

Jeff Kramer Behavior Analyst & Autism Specialist Folsom Cordova Unified School District

Meryl E. Lipton, M.D., Ph.D. Rush NeuroBehavioral Center Rush University Medical Center

Sergio Aguilar-Gaxiola, M.D., Ph.D. Professor, Department of Internal Medicine Director, Center for Reducing Health Disparities (CRHD) Director, Community Engagement Program of the Clinical Translational Science Center (CTSC)

Khyati Brahmbhatt, M.D. Assistant Clinical Professor Department of Psychiatry and Behavioral Sciences

Sufen Chiu, M.D., Ph.D. Assistant Clinical Professor Department of Psychiatry and Behavioral Sciences

Elizabeth N. Gutierrez , M.D. Department of Psychiatry and Behavioral Sciences

Ingrid N. Leckliter, Ph.D. Licensed Clinical Psychologist Associate Clinical Professor, Department of Pediatrics UC Davis MIND Institute

Kathleen Angkustsiri, M.D. Assistant Professor of Pediatrics UC Davis MIND Institute

Maureen Burness SELPA (Special Education Local Plan Area) Director Folsom Cordova Unified School District Sacramento, California

Eun Mi Cho, Ed.D. Associate Professor Department of Special Education, Rehabilitation, School Psychology, and Deaf Studies Sacramento State University

Terri Contenti Community Relations Officer UC Davis MIND Institute

Sharon E. Fallis Consultant, Youth and Young Adult Advocacy Projects Center for Excellence in Developmental Disabilities UC Davis MIND Institute

Gina Guarneri, M.A. Community Services Coordinator Center for Excellence in Developmental Disabilities UC Davis MIND Institute

Ronald Huff, Ph.D. Director, Clinical and Intake Services Alta California Regional Center Sacramento, CA

Lori A. Llewelyn, M.P.P. Associate Director, Administration Center for Excellence in Developmental Disabilities UC Davis MIND Institute

Catherine Mikitka Supporting Early Education Delivery Systems (SEEDS) Sacramento, CA

Angie Rivera Founding Member, Fiesta Educativa Consultant, Latino Outreach Center for Excellence in Developmental Disabilities UC Davis MIND Institute

Kathleen Sadao, Ed.D. Supporting Early Education Delivery Systems (SEEDS) Sacramento, CA

Lynne Weissmann Co-Founder, Sacramento Asperger Syndrome Information & Support Elk Grove, CA

Lucia A. Milburn, Ph.D. Licensed Clinical Psychologist Children’s Hospital and Research Center, Oakland

Shane Nurnberg Rowell Family Empowerment Autism-Epicenter.com

Mark Starford Executive Director Board Resource Center, Inc.

Louis A. Vismara, M.D. Policy Consultant to Senator Darrell Steinberg, California Office of the President Pro Tempore California State Senate Board Chair and Founding Member UC Davis MIND Institute

Robin L. Hansen, M.D., ChairProfessor of PediatricsDirector, Center for Excellence in Developmental DisabilitiesDirector of Clinical ProgramsUC Davis MIND Institute

Eun Mi Cho, Ed.D.Associate ProfessorDepartment of Special Education, Rehabilitation, School Psychology, and Deaf StudiesSacramento State University

CONFERENCE COORDINATOR

Larry JacinthCME SpecialistContinuing Medical EducationUC Davis Health System

ACCREDITATIONThe University of California Davis Health System is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

CREDIT DESIGNATIONPhysician Credit: The University of California Davis Health System designates this live activity for a maximum of 6.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

ACCREDITATIONThis activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the University of California Davis Health System and the Sacramento State University Division of Nursing and Department of Special Education, Rehabilitation, School Psychology and Deaf Studies. The University of California Davis Health System is accredited by the ACCME to provide continuing medical education for physicians.

AAFP: Application for CME credit has been filed with the American Academy of Family Physicians. Determination of credit is pending.

AMA PRA Category 1 Credits™ acceptable formultidisciplinary team members

Nurse: For the purpose of recertification, the American Nurses Credentialing Center accepts AMA PRA Category 1 Credits™ issued by organizations accredited by the ACCME. For the purpose of relicensure, the California Board of Registered Nursing accepts AMA PRA Category 1 Credits™ (report hours of credit and fill in “CME Category 1” for the provider number).

Physician Assistant: The National Commission on Certification of Physician Assistants (NCCPA) states that AMA PRA Category 1 Credits™ are acceptable for continuing medical education requirements for recertification.

Psychologist: This educational activity is recognized by the California Board of Psychology as meeting the continuing education requirements toward license renewal for California psychologists (self reporting required).

Speech and Language Pathologist: California SLP license renewal: The California Speech-Language Pathology and Audiology Board recognizes continuing professional development services from accredited organizations approved as continuing education providers by the California Medical Association’s Institute for Medical Quality Continuing Education. American Speech-Language-Hearing Association Certification: Individuals must request permission from ASHA to use this credit to satisfy continuing professional development requirements. For more information: http://www.asha.org.

ADDITIONAL CREDIT DESIGNATIONMFT and LCSW: UC Davis Health System Office of Continuing Medical Education, Provider No. PCE 2354. This course meets the qualifications for 6.5 hours of continuing education credit for marriage and family therapists and/or licensed clinical social workers as required by the California Board of Behavioral Sciences. Participants must attend the entire course, write license number on the roster, and complete the course evaluation to earn credit.

ENROLLMENTPlease register early – space is limited.Tuition is $175 for health-care and other professionals, $100 for students or parents/caregivers. Two parents/caregivers in the same family registering together qualify for a special rate of $150 for both participants. Students and parents/caregivers registering at this discounted rate will not receive continuing education credit or certificates of attendance. Confirmation of registration will be sent within two weeks after receipt of enrollment form. The fees will increase after July 15, 2011.

Registration forms received without payments will not be processed until payment is received, and payment must follow within 10 days. Early discount rates are honored if payment is received by the date noted on the enrollment form. After that date, the late fee is applied.

GROUP ENROLLMENTGroups of five or more professionals from the same agency qualify for the discounted group rate of $160 per person. All enrollment applications from the group must be mailed or faxed together with a cover sheet including the following information: contact name and phone number, name of agency, list of participants, and payment method. Each registration form should be completed with home address information to ensure delivery of parking permits. Group discounts are not available after July 15, 2011.

Confirmation notices, registration fee receipts, and Sacramento State parking permits will be mailed to participants at the address submitted on the registration form. Lost parking permits will not be replaced.

Tuition includes continental breakfast, lunch, refreshment breaks, syllabus, and Sacramento State parking fee. For participants paying the health-care professional fee, tuition includes certificates of attendance. File your certificates for safekeeping. Duplicate certificates will be an additional $10. Tuition may be paid by check, American Express, Discover, MasterCard or VISA. Cash is not accepted. Refunds must be requested by July 15, 2011, and will be subject to a $25 service charge. Program materials cannot be guaranteed unless enrollment is received by July 15, 2011. The Office of Continuing Medical Education reserves the right to cancel this program. In such a case, a full refund will be given.

BROCHURE ART CREDITBrochure images courtesy of Accreditation Council for Continuing Medical Education, UC Davis Public Affairs, MIND Institute, Sacramento State University, and iStockPhoto.com.

FOR FURTHER INFORMATIONUC Davis Health SystemOffice of Continuing Medical Education3560 Business Drive, Suite 130Sacramento, CA 95820-2161

1 (866) CME4EDU (263-4338)(916) 734-5390

Fax (916) 734-0742http://cme.ucdavis.edu

Continuing Education Units for EducatorsOffered by Sacramento State College of Continuing EducationCourse Code 11R SPED 60301 | 0.65 CEUEducators requiring CEU must complete all forms and submit an additional fee of $55 at the conference (payable by credit card or check to Sacramento State). Sacramento State CEU information will be available in the registration area at the conference. Do not mail payment to UCDHS OCME with your conference registration materials. Completed registration forms, fees and evaluation forms will be collected by UCDHS CME staff in the Lobby Suite registration area on Friday, August 5, 3-4:45 pm

Visitor Info.

Union Ballroom

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LOCATIONUNIVERSITY UNION BALLROOMSACRAMENTO STATE UNIVERSITY6000 J Street, Sacramento, CA 95819

The University Union Ballroom is located in the University Union on the campus of Sacramento State University. The keynote lecture will be held in the Ballroom and concurrent session locations will be identified in course materials provided at the conference.

Layered clothing is recommended as the meeting room temperature may be uncomfortable for some, depending on personal preferences.

If you have any special needs due to a disability as specified in the Americans with Disabilities Act, please call the Office of Continuing Medical Education at (916) 734-5390 so we may make the necessary accommodations for you.

PARKING Parking fees are included in the tuition. Parking permits and Sacramento State campus maps for parking lot locations will be mailed to participants with UC Davis CME registration acknowledgements and receipts for fees. Requests for parking permits must be received by July 15, 2011. Lost permits will not be replaced. Directions, parking information and maps are available on the UC Davis CME web site: http://cme.ucdavis.edu.

DRIVING DIRECTIONSFor detailed driving directions, see the Sacramento State web site: http://www.csus.edu/pa/directions/html.

UC DAVIS HEALTH SYSTEM CME MISSIONIn concert with the University of California Davis Health System mission of discovering and sharing knowledge to advance health, the continuing medical education mission focuses on the lifelong learning commitments of physicians who practice in the health system and in the greater Northern California region. UC Davis CME is at the nexus between scientific discovery and its translation to practice with a commitment to provide a variety of educational formats for evidence-based education that fulfills identified needs and produces changes in physician practice resulting in improved competence, performance and/or patient care. With an emphasis on multidisciplinary programs, content is based on competencies and bona fide needs assessments as well as clinical requirements. The CME Advisory Committee reviews the content and quality of CME offerings in accordance with the Accreditation Council for Continuing Medical Education’s Essential Areas and Their Elements and the American Medical Association’s Physician Recognition Award accredited provider information.

DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPSAs a provider accredited by the Accreditation Council for Continuing Medical Education, the University of California Davis Health System Office of Continuing Medical Education must ensure balance, independence, and objectivity in all CME activities to promote improvements in health care and not proprietary interests of a commercial interest. The provider controls all decisions related to identification of CME needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a position to control the content, selection of educational methods, and evaluation of the activity. Course directors, planning committee members, presenters, authors, moderators, panel members, and others in a position to control the content of this activity are required to disclose relevant financial relationships with commercial interests related to the subject matter of this educational activity. Learners are able to assess the potential for commercial bias in information when complete disclosure, resolution of conflicts of interest, and acknowledgment of commercial support are provided prior to the activity. Informed learners are the final safeguards in assuring that a CME activity is independent from commercial support. We believe this mechanism contributes to the transparency and accountability of CME.

AIR TRAVEL TO SACRAMENTO INTERNATIONAL AIRPORT (SMF)

The Office of Continuing Medical Education has arranged group rates with United Airlines. Please read and follow the directions carefully to obtain this special rates for your travel to our conference.

United Airlines: Please call United Airlines at (800) 521-4041 between 7:00 am & 12:00 am ET, to take advantage of this conference’s discounts by mentioning account code #552QB. Discounts include 5% off the lowest, unrestricted coach fare (some restrictions apply) when you travel to the meeting site (mileage plus applies). United specialists will explain any restrictions and make reservations for you. If you purchase from a local agent, be sure the agent calls the 800 number and uses the account code. Fares are guaranteed at the time of ticket purchase.

GROUND TRANSPORTATIONHertz Car Rental: 1 (800) 544-2240 and request ID CR#04H70001 for discounted rates.National Car Rental: 1 (800) CAR-RENT and request ID #5282865 for discounted rates.http://supershuttle.com

In accordance with applicable State and Federal laws and University policy, the University of California does not discriminate in any of its policies, procedures, or practices on the basis of race, color, national origin, religion, sex, sexual orientation, handicap, age, veterans status, medical condition (cancer-related), ancestry, or marital status as defined in Section 12926 of the California Government Code; nor does the University discriminate on the basis of citizenship, within the limits imposed by law or University policy. In conformance with the applicable law and University policy, the University of California is an affirmative action/equal opportunity employer. Inquiries regarding the University’s equal opportunity policies may be directed to the Vice Chancellor of Academic Affairs-Affirmative Action Officer and Title IX Coordinator at University of California, Davis, 525 Mrak Hall, Davis, CA 95616.

ENROLLMENT APPLICATION The Summer Institute on(Please Print) Neurodevelopmental Disorders August 5, 2011

Physician information required for CME credit and name badge.Please indicate primary medical specialty: PED PSY PSY/Child NEURO FP GP IM Other (specify) ________________________________

Social Security Number (last 4 digits required for transcript purposes)

Please copy the mail code from the address side of the brochure (above your name, e.g. PPMIND, MMSMIND, CRDMIND) _________________________________

If you did not receive a brochure in the mail, how did you hear about this conference?(Example: PT&MG, UCD website, web search, magazine, friend)_________________________________________________________________________________

Have you attended this conference in the past? Yes No

For Office Use Only

MND2012

6006

REGISTER ONLINE AT: http://cme.ucdavis.edu/conferences

Send Sacramento lodging information.

If you need disability accommodations at the meeting, please let us know by July 15, 2011 and our representative will contact you.

Please note special dietary/food allergy requirements: _________________________________

Please check your payment method:Registration forms received without check, credit card number or purchase order number will not be processed until payment is received.

Check enclosed payable to: UC Regents

AMEX Discover MasterCard VISA

______________________________________________________________________________Account Number Expiration Date

______________________________________________________________________________Authorized Signature (name on card) Security Code

Telephone: (916) 734-5390

Fax application (916) 734-0742

Please use ONE of these methods to register: (Do not mail if previously faxed or telephoned)

Mail application and payment to:Office of Continuing Medical Education,c/o UC Davis Cashier’s OfficePO Box 989062, West Sacramento, CA 95798-9062

_______________________________________________________________________________________________________________________________________First Name M.I. Last Name

MD DO PhD PA NP RN OT PT SLP Psychologist Educator

Student Parent/Caregiver LCSW Lic# ____________________ MFT Lic# _____________________ Other: ______________________

_______________________________________________________________________________________________________________________________________Institution/Employer (as you would like it to appear on your badge) Profession/Occupation

_______________________________________________________________________________________________________________________________________Home Address (to ensure delivery of parking permit)

_______________________________________________________________________________________________________________________________________City State Zip Code

_______________________________________________________________________________________________________________________________________Day Phone Fax Number

_______________________________________________________________________________________________________________________________________E-Mail

( ) ( )

WORKSHOP ENROLLMENT Please circle first and second choices for each concurrent session.

You will be enrolled in the first choice if possible. If the first choice is filled, you will be enrolled in the second choice. Your registration acknowledgment will include selected sessions.

Advocacy and Family: 1 or 2, 8, 12, 15 Interventions: 3, 7, 9 or 10, 14 Neurodevelopmental Disorders: 4, 5 or 6, 11, 13

First Choice Second Choice10:15 am 1 2 3 4 1 2 3 412:45 pm 5 6 7 8 5 6 7 82:30 pm 9 10 11 12 9 10 11 124:15 pm 13 14 15 13 14 15

REGISTRATION FEES (Receipt/Confirmation will be mailed within two weeks) Early Discount After July 15th Health-care and Other Professionals $175 $210 Students (CSUS, UCD, others – No Credit) $100 $120 Parents/Caregivers (No Credit) $100 $120 2 Parents/Caregivers registered together (No Credit) $150 $180 Group Rate: 5 or more professionals registered together $160 each No Group Rate

PARKING PERMIT

YES, I will need a Parking Permit

NO, I do not need a Parking Permit

If you cannot attend…please give brochure to a colleague!

DATED MATERIAL

University of California, DavisOffice of Continuing Medical Education3560 Business Drive, Suite 130Sacramento, CA 95820-2161

HIGHLIGHTS■NeurodevelopmentalDisordersAcrosstheLifespan:ResearchtoPractice■Keynote:AutismResearchandPolicy–AFamilyJourney■DualDiagnoses■GeneticandMetabolicEvaluationofDevelopmentalDelay■AdvocacyandFamilySupport■TouchTechnologyAppsforPeoplewithDisabilities■Cross-culturalCommunication■AskMeSessions:Extratimeforparticipantstoaskquestionsof

presentersandfamilymembersofpeoplewithdisabilities

Non-profit Org.U.S. Postage

PAIDSacramento, CAPermit No. 3405

THE SUMMER INSTITUTEON NEURODEVELOPMENTAL DISORDERS ACROSS THE LIFESPAN: RESEARCH TO PRACTICEAUGUST 5, 2011FRIDAY

UNIVERSITY UNION BALLROOMSACRAMENTOSTATEUNIVERSITY•SACRAMENTO,CA

This program is self-supporting and receives no state funding.

10% POST CONSUMER WASTE

PAST PARTICIPANT COMMENTS

“Theoveralltrainingwaswellorganized,withalotofuseful,informativeanduptodateinformationfromsomeofthemostrecognizedresearchersinASD.Ilearnedalot.”

“Thankyouformakingvideotapesoftheconferencesavailable.Itwashardtoselectamongsomanyexcellenttopics.”

“Ialwaysfeelre-energizedandreadytostartthefalltermwithupdatedinformationforfamiliesandschoolstaff.”