8
www.ACRM.org T: +1.703.435.5335 REG FORM PG 1 ¨ Dr. ¨ Mr. ¨ Mrs. ¨ Ms. First Name Last Name Credential Primary Title Organization Mailing Address line 1 Mailing Address line 2 City State / Province Zip / Postal Code Country Phone Registrant Email Emergency Contact Name Emergency Contact Phone Credential Secondary BEST * RATE * EARLY BIRD REGULAR ON-SITE PLEASE SEE THE PRICING WEB PAGE TO VIEW RATE CLOSING DATES: www.ACRM.org/pricing CORE: 3.5 DAYS £ STUDENT / £ RESIDENT / £ FELLOW MEMBER ¨ 449 ¨ 449 ¨ 549 ¨ 649 NON-MEMBER ¨ 549 ¨ 549 ¨ 649 ¨ 749 CORE: 3.5 DAYS £ CONSUMER / £ EARLY CAREER MEMBER ¨ 599 ¨ 599 ¨ 699 ¨ 899 NON-MEMBER ¨ 699 ¨ 699 ¨ 799 ¨ 999 CORE: 3.5 DAYS EVERYONE ELSE MEMBER ¨ 649 ¨ 699 ¨ 749 ¨ 1,199 NON-MEMBER ¨ 799 ¨ 849 ¨ 899 ¨ 1,349 ONE DAY: SELECT: £ THU £ FRI £ SAT MEMBER ¨ 449 ¨ 449 ¨ 499 ¨ 599 NON-MEMBER ¨ 549 ¨ 549 ¨ 599 ¨ 699 HALF DAY WED: 1:30 PM – 8:30 PM MEMBER ¨ 349 ¨ 349 ¨ 349 ¨ 399 NON-MEMBER ¨ 449 ¨ 449 ¨ 449 ¨ 499 Registration Date ACRM COMMUNITY GROUPS Non-member registration includes 6-month introductory ACRM membership. Please select the ACRM groups that are most relevant to you, so we may introduce you to opportunities and benefits available: ¨ Arts & Neuroscience Group ¨ Brain Injury Interdisciplinary Special Interest Group (BI-ISIG) ¨ Cancer Networking Group ¨ Complementary, Integrative Rehabilitation Medicine Group ¨ Early Career Networking Group ¨ Geriatric Rehabilitation Networking Group ¨ Health Policy Networking Group ¨ International Networking Group ¨ Limb Restoration Rehab. Group ¨ Measurement Outcomes Networking Group ¨ Military / Veterans Affairs Networking Group ¨ Neurodegenerative Diseases Networking Group ¨ Neuroplasticity Networking Group ¨ Pain Rehabilitation Group ¨ Pediatric Networking Group ¨ Physician/Clinicians Networking Group ¨ Spinal Cord Injury Interdisciplinary Special Interest Group (SCI-ISIG) ¨ Stroke Interdisciplinary Special Interest Group (STROKE-ISIG) ¨ Technology Networking Group REGISTER Online at www.ACRM.org OR complete this form and submit via email, fax or mail (see last page). > ATTENDEE TYPE (Check all that apply.) ¨ Consumer/Survivor ¨ Early Career ¨ Exhibitor ¨ Presenter (Instructional Course) ¨ Presenter (Paper/Poster) ¨ Presenter (Symposia) ¨ Rehabilitation Professional ¨ Student / Resident / Fellow > ¨ Check here to opt out of receiving a small number of informative emails prior to the conference from ACRM on behalf of conference sponsors and exhibitors. ¨ First-time attendee WED 1:30 PM THROUGH SAT 26 - 28 OCT INCLUDES access to all sessions from WED 1:30 PM through SAT including symposia, plenaries, featured sessions, awards lectures, evening receptions*, posters, ACRM ISIG/networking community group meetings, and the ACRM EXPO. CORE PLEASE ENTER INFO BELOW AS YOU WANT IT TO APPEAR ON YOUR CONFERENCE NAME BADGE NOTE: THERE IS SPACE FOR ONLY 2 CREDENTIALS ON YOUR NAME BADGE *The Henry B. Betts Award Gala & Dinner Friday night is not included in the CORE conference pass. The Gala is included in the WORLD PASS (see page 2) and is available for purchase separately (see page 4). A few community group meetings are by invitation only. 3.5-DAY CORE PASS 3.5-DAY ACRM 94 th Annual Conference 23 – 28 OCT 2017 ATLANTA USA INT ERD ISC IP L INA RY ATLANTA HILTON PROGRESS IN REHABILITATION RESEARCH # PIRR2017

PASS COMPARISON - ACRMacrm.org/wp-content/uploads/2017/01/PIRR17_Conf... · ¨ Neurodegenerative Diseases Networking Group ¨ Neuroplasticity Networking Group ... £ 8:30 AM - 12:30

  • Upload
    others

  • View
    7

  • Download
    0

Embed Size (px)

Citation preview

www.ACRM.org T: +1.703.435.5335REG FORM PG 1

¨ Dr. ¨ Mr. ¨ Mrs. ¨ Ms.

First Name

Last Name

Credential Primary

Title

Organization

Mailing Address line 1

Mailing Address line 2

City

State / Province Zip / Postal Code

Country

Phone

Registrant Email

Emergency Contact Name

Emergency Contact Phone

Credential Secondary

BEST * R A T E * EARLY BIRD REGULAR ON-SITE

PLEASE SEE THE PRICING WEB PAGE TO VIEW RATE CLOSING DATES:www.ACRM.org/pricing

CORE: 3.5 DAYS£ STUDENT / £ RESIDENT / £ FELLOW

MEMBER ¨ 449 ¨ 449 ¨ 549 ¨ 649 NON-MEMBER ¨ 549 ¨ 549 ¨ 649 ¨ 749

CORE: 3.5 DAYS £ CONSUMER / £ EARLY CAREER

MEMBER ¨ 599 ¨ 599 ¨ 699 ¨ 899 NON-MEMBER ¨ 699 ¨ 699 ¨ 799 ¨ 999

CORE: 3.5 DAYSEVERYONE ELSE

MEMBER ¨ 649 ¨ 699 ¨ 749 ¨ 1,199 NON-MEMBER ¨ 799 ¨ 849 ¨ 899 ¨ 1,349

ONE DAY:SELECT: £ THU £ FRI £ SAT

MEMBER ¨ 449 ¨ 449 ¨ 499 ¨ 599 NON-MEMBER ¨ 549 ¨ 549 ¨ 599 ¨ 699

HALF DAY WED:1:30 PM – 8:30 PM

MEMBER ¨ 349 ¨ 349 ¨ 349 ¨ 399 NON-MEMBER ¨ 449 ¨ 449 ¨ 449 ¨ 499

Registration DateACRM COMMUNITY GROUPS Non-member registration includes 6-month introductory ACRM membership. Please select the ACRM groups that are most relevant to you, so we may introduce you to opportunities and benefits available:

¨ Arts & Neuroscience Group

¨ Brain Injury Interdisciplinary Special Interest Group (BI-ISIG)

¨ Cancer Networking Group

¨ Complementary, Integrative Rehabilitation Medicine Group

¨ Early Career Networking Group

¨ Geriatric Rehabilitation Networking Group

¨ Health Policy Networking Group

¨ International Networking Group

¨ Limb Restoration Rehab. Group

¨ Measurement Outcomes Networking Group

¨ Military / Veterans Affairs Networking Group

¨ Neurodegenerative Diseases Networking Group

¨ Neuroplasticity Networking Group

¨ Pain Rehabilitation Group

¨ Pediatric Networking Group

¨ Physician/Clinicians Networking Group

¨ Spinal Cord Injury Interdisciplinary Special Interest Group (SCI-ISIG)

¨ Stroke Interdisciplinary Special Interest Group (STROKE-ISIG)

¨ Technology Networking Group

REGISTER Online at www.ACRM.org OR complete this form and submit via email, fax or mail (see last page).

>

ATTENDEE TYPE (Check all that apply.) ¨ Consumer/Survivor

¨ Early Career

¨ Exhibitor

¨ Presenter (Instructional Course)

¨ Presenter (Paper/Poster)

¨ Presenter (Symposia)

¨ Rehabilitation Professional

¨ Student / Resident / Fellow

>

¨ Check here to opt out of receiving a small number of informative emails prior to the conference from ACRM on behalf of conference sponsors and exhibitors.

¨ First-time attendee

WED 1:30 PM THROUGH SAT 26 - 28 OCT

INCLUDES access to all sessions from WED 1:30 PM through SAT including symposia, plenaries, featured sessions, awards lectures, evening receptions*, posters, ACRM ISIG/networking community group meetings, and the ACRM EXPO.

CO

REPLEASE ENTER INFO BELOW AS YOU WANT IT TO

APPEAR ON YOUR CONFERENCE NAME BADGE

NOTE: THERE IS SPACE FOR ONLY 2 CREDENTIALS ON YOUR NAME BADGE

*The Henry B. Betts Award Gala & Dinner Friday night is not included in the CORE conference pass. The Gala is included in the WORLD PASS (see page 2) and is available for purchase separately (see page 4). A few community group meetings are by invitation only.

3.5-

DA

Y

CORE PASS 3.5-DAY

ACRM 94th Annual Conference 23 – 28 OCT 2017 ATLANTA USA I N T E R D I S C I P L I N A R YATLANTA HILTON

PROGRESS IN REHABILITATION RESEARCH #PIRR2017

www.ACRM.org T: +1.703.435.5335REG FORM PG 2

BEST * R A T E * EARLY BIRD REGULAR ON-SITE

PLEASE SEE THE PRICING WEB PAGE TO VIEW RATE CLOSING DATES:www.ACRM.org/pricing

HUGE SAVINGS SAVE NEARLY 50% OFF a la carte pricing

WORLD PASS£ STUDENT / £ RESIDENT / £ FELLOW

MEMBER ¨ 699 ¨ 699 ¨ 799 ¨ 899 NON-MEMBER ¨ 799 ¨ 799 ¨ 899 ¨ 999

WORLD PASS£ CONSUMER / £ EARLY CAREER

MEMBER ¨ 799 ¨ 799 ¨ 899 ¨ 999 NON-MEMBER ¨ 849 ¨ 849 ¨ 949 ¨ 1,149

WORLD PASSEVERYONE ELSE

MEMBER ¨ 899 ¨ 899 ¨ 999 ¨ 1,399 NON-MEMBER ¨ 999 ¨ 999 ¨ 1,099 ¨ 1,499

*Please NOTE: these SPECIAL COURSES are available for purchase separately and are NOT included in the WORLD PASS: Cognitive Rehabilitation Training, ACBIS National Certification Training Program, and ticketed luncheon lectures.

BEST VALUE

MON - TUE - WED - THU - FRI - SAT 23 - 28 OCT

INCLUDES access to all SIX days*: CORE registration PLUS access to all Pre-Conference Instructional Courses, Early Career Development Course, Parkinson’s Disease Course for Speech Language Pathologists, CME/CEU credits, ticket to the Henry B. Betts Awards Dinner & Gala, and conference slides (PDFs).

(Prices in parenthesis below indicate the a la car te cost if purchased separately from the WORLD PASS.)

WO

RLD

PA

SS

6-D

AY

3.5 DAY CORE PASS

6-DAY WORLD PASS

WORLD PASS PURCHASERS

PLEASE SELECT FROM BELOW IF YOU WISH TO ATTEND / USE THESE ITEMS

INCLUDED IN YOUR WORLD PASS

PRICE RANGES OF *BEST* RATES

$449 - 799 $699 - 999

CORE CONFERENCE: P PEducational Symposia WED – FRI: 250+ sessions & lectures P P4 Plenary Sessions (Ulicny, Briggs, Corbetta, Rimmer) P PModerated Panel Discussions P PAwards Lectures P PScientific Posters — hundreds! P PACRM Community Meetings:̊ Interdisciplinary Special Interest Groups (ISIGs), Networking Groups, Task Forces & Committees. A few are invitation only P PHenry B. Betts Awards Gala: FRI evening ($149 - 199) P ¨

CME/CEU credits for CORE CONFERENCE ($149) P ¨

ACRM EXPO: P P Poster Grand Rounds P P Chat with the Experts P P Product Theater P P

Reception I in EXPO / POSTER Hall: WED evening P P ¨

Reception II in EXPO / POSTER Hall: THU evening P P ¨

INSTRUCTIONAL COURSES: MON, TUE, WED, SAT ($99.50 - 696.50) P Early Career Development Course: WED ($249 - 599) P ¨

Parkinson’s Disease Course for Speech Language Pathologists: SAT ($249 - 599) P

Conference Slides / PDFs ($99 - $749) Digital access to all available symposia and pre-conference instructional course slide presentations (PDFs). A few content leaders elect not to have their slides available to attendees, therefore some sessions may not be included. Cognitive Rehabilitation Training and Early Career Development Course are not included.

P ¨

WORLD PASS 6-DAY

PASS COMPARISON

Denotes the item is INCLUDED in the WORLD PASS

ACRM 94th Annual Conference 23 – 28 OCT 2017 ATLANTA USA I N T E R D I S C I P L I N A R YATLANTA HILTON

PROGRESS IN REHABILITATION RESEARCH #PIRR2017

www.ACRM.org T: +1.703.435.5335REG FORM PG 3

INSTRUCTIONAL COURSES (ICs)ATTN WORLD PASS purchasers!

• Make your course selections from the list below. • These are included in your WORLD PASS.• Check here if you will not be attending these courses • You will have the opportunity to change your selections later.

$99.50 each half-day block BEST RATE• Members / non-members same price.• Continuing education credits are included.

BEST RATE EARLY BIRD REGULAR ON-SITE

99.50 99.50 149.50 199.50

< Unless otherwise noted, IC pricing & registration is for half-day blocks and lunch is not included. One day block would be x2. See the WORLD PASS for best value.

MONDAY 23 OCT TOPICS£ 8:30 AM - 12:30 294674 How to Deliver the Wheelchair Skills Training Program in the Clinic and Beyond CROSS-CUTTING

£ 8:30 AM - 12:30 295192 Rising Above the Stereotypes to Create a Successful Interdisciplinary Team (Part 1) CROSS-CUTTING

£ 8:30 AM - 12:30 296024 ICU Rehabilitation: Current State of the Evidence and Implementation Science (Part 1) CLINICAL PRACTICE

£ 1:30PM - 5:30PM 282464 Improving carry-over: A Practical Lab on Approaches for Translating Therapeutic Gains CLINICAL PRACTICE

£ 1:30PM - 5:30PM 295192 Rising Above the Stereotypes to Create a Successful Interdisciplinary Team (Part 2) CROSS-CUTTING

£ 1:30PM - 5:30PM 296024 ICU Rehabilitation: Current State of the Evidence and Implementation Science (Part 2) CLINICAL PRACTICE

TUESDAY 24 OCT

£ 8:30 AM - 12:30 289945 Integrating Outcome Measurement into Clinical Practice CROSS-CUTTING

£ 8:30 AM - 12:30 293316 Neuromuscular stimulation to improve function in Pediatrics PEDIATRIC REHABILITATION

£ 8:30 AM - 12:30 294466 An Introduction to Longitudinal Data Analysis (Part 1) STATISTICAL MODELING

£ 8:30 AM - 12:30 296911 Shifting Focus: Delivering Peer-led, Person-centered Support In SCI Rehab, Community Settings CLINICAL PRACTICE

£ 8:30 AM - 12:30 297052 A Clinician’s Guide to Finding and Interpreting Data to Support Your Evidence-Based Practice CLINICAL PRACTICE

£ 8:30 AM - 12:30 297087 Enhancing TBI Research Baseline & Outcomes Measurement w/Biomarkers & Biometrics (Part 1) BRAIN INJURY

£ 8:30 AM - 12:30 300062 Neuropharmacology Overview: Basic Science, Clinical Use & Future Direction (Part 1) CLINICAL PRACTICE

£ 8:30 AM - 12:30 304782 Management of Neurodegenerative Disorders w/Ayurveda & Yoga: Interdisciplinary Considerations NEURODEGENERATIVE DISEASES

£ 1:00 PM - 4:30 PM302250 at Shepherd Center TRANSPORTATION ON OWN Insights into an Integrative and

Comprehensive Approach to Management of Multiple Sclerosis (Part 1)NEURODEGENERATIVE DISEASES & CLINICAL PRACTICE

£ 1:30 PM - 5:30 PM 309187 Dynamic Neuro-Cognitive Imagery Training for Enhancing Motor Performance in People with Parkinson’s Disease NEURODEGENERATIVE DISEASES & GERIATRIC

£ 1:30 PM - 5:30 PM 284670 Integrative Management of Chronic Pain using Autonomic Self-Regulation COMPLEMENTARY INTEGRATIVE MEDICINE

£ 1:30 PM - 5:30 PM 294181 Reducing the Likelihood of Post-Concussive Syndrome Thru Effec. Assessmen/Education/Treatment CLINICAL PRACTICE

£ 1:30 PM - 5:30 PM 294384 Applied Longitudinal Data Analysis Using R (Part 2) STATISTICAL MODELING

£ 1:30 PM - 5:30 PM 294693 Implementing a Patient/Family Driven Care Program using Goal Attainment Scaling CROSS-CUTTING

£ 1:30 PM - 5:30 PM 296808 Brief PTSD Treatment in Rehabilitation Settings Using the “Battlefield Variant” Protocol CLINICAL PRACTICE

£ 1:30 PM - 5:30 PM 297040 New EEG & Multimodal Tools for Communication and Rehab for Users w/Severe Motor Disabilities NEURODEGENERATIVE DISEASES

£ 1:30 PM - 5:30 PM 297087 Enhancing TBI Research Baseline & Outcomes Measurement w/Biomarkers & Biometrics (Part 2) BRAIN INJURY

£ 1:30 PM - 5:30 PM 300062 Neuropharmacology Overview: Basic Science, Clinical Use, & Future Direction (Part 2) CLINICAL PRACTICE

WEDNESDAY 25 OCT MORNING ONLY COURSES

£ 8:00 AM - 3:00 PM 297424 Early Career Development COURSE — LUNCH INCLUDED see: ACRM.org/ecdc EARLY CAREER CROSS-CUTTING

£ 8:30 AM - 12:30 281574 Objective Assessment of Gait Function in People Living w/NDD Conditions Using Mobile Technolo NEURODEGENERATIVE DISEASES

£ 8:30 AM - 12:30 295894 Beyond Acute Care; Promoting Self-Management and Empowering Clients to Live a Fuller Life CLINICAL PRACTICE & MEASUREMENT

£ 8:30 AM - 12:30 284339 Programmatic Development: An Instructional Course And Workshop For Rehabilitation Clinicians CLINICAL PRACTICE & MEASUREMENT

£ 8:30 AM - 12:30 297160 Management of Children With Upper and Lower Extremity Limb Deficiencies: Congenital & Acquired LIMB RESTORATION & PEDIATRICS

£ 8:30 AM - 12:30 285180 How to: Administering the Kessler Found. Neglect Assessment Process & Prism Adaptation Treat... STROKE

£ 8:30 AM - 12:30 288094 How Peers Can Be Integrated Into Rehabilitation Care Provision:Learn From a Peer Support Team... SPINAL CORD INJURY

£ 8:30 AM - 12:30 288985 Concussion: Managing Recovery Inertia in Complex Phenotypes: A Case Study Model BRAIN INJURY

£ 8:30 AM - 12:30 290429 Adapted Tango Instruction for Older Adults & People With Movement Disorders: Fundamentals ARTS & NEUROSCIENCE

£ 8:30 AM - 12:30 293537 Optimizing Transitions of Care in Stroke Rehab, From Day One to Community Reintegration STROKE

£ 8:30 AM - 12:30 294965 Contemporary Applications of Biofeedback for Patients: Mind-body Approaches to Rehabilitation COMPLEMENTARY INTEGRATIVE MEDICINE

£ 8:30 AM - 12:30 297047 Improving Recognition & Treatment of Sleep Apnea in the Rehab Setting to Improve Outcome CROSS-CUTTING

£ 8:30 AM - 12:30 297321 Stimulating Neurorecovery Using Transcranial Direct Current Stimulation NEUROPLASTICITY

£ 8:30 AM - 12:30 297352 Evaluating Evidence for Use in Everyday Practice CLINICAL PRACTICE

£ 8:30 AM - 12:30 300300 The NIH Toolbox: State of the Art Outcome Measures for Rehabilitation Practice & Research CROSS-CUTTING

£ 8:30 AM - 2:30 PM 302250 at HILTON Insights into an Integrative & Comprehensive Approach to Management of MS (Part 2) NEURODEGENERATIVE DISEASES & CP

SATURDAY 28 OCT£ 8:00 AM - 5:00 PM 313279 Parkinson’s Disease COURSE for Speech Language Pathologists — LUNCH INCLUDED

see: ACRM.org/pdfcourse

NEURODEGENERATIVE DISEASES

£ 8:00 AM - 12:00 PM 334413 Dance Tools to Help Physical and Occupational Therapists Broaden Vocabulary and Approach COMPLEMENTARY INTEGRATIVE MEDICINE

£ 8:00 AM - 11:30 AM 300216 Integrating Feldenkrais® Concepts Into Rehabilitation: A Systems Based Approach (Part 1) COMPLEMENTARY INTEGRATIVE MEDICINE

£ 12:00 PM - 4:00 PM 300216 Integrating Feldenkrais® Concepts Into Rehabilitation: A Systems Based Approach (Part 2) COMPLEMENTARY INTEGRATIVE MEDICINE

$

$

$ While these courses are included in the WORLD PASS, only these include lunch and have a separate pricing structure when purchased a la carte — please see next page. Advance registration is required. These events will likely sell-out.

ID CODE

ACRM 94th Annual Conference 23 – 28 OCT 2017 ATLANTA USA I N T E R D I S C I P L I N A R YATLANTA HILTON

PROGRESS IN REHABILITATION RESEARCH #PIRR2017

www.ACRM.org T: +1.703.435.5335REG FORM PG 4

BEST * R A T E * EARLY BIRD REGULAR ON-SITE

PLEASE SEE THE PRICING WEB PAGE TO VIEW RATE CLOSING DATES:www.ACRM.org/pricing

MEMBER ¨ 249 ¨ 299 ¨ 349 ¨ 449

NON-MEMBER ¨ 349 ¨ 399 ¨ 499 ¨ 599

BEST * R A T E * EARLY BIRD REGULAR ON-SITE

PLEASE SEE THE PRICING WEB PAGE TO VIEW RATE CLOSING DATES:www.ACRM.org/pricing

MEMBER ¨ 249 ¨ 299 ¨ 349 ¨ 449

NON-MEMBER ¨ 349 ¨ 399 ¨ 499 ¨ 599

EARLY CAREER DEVELOPMENT COURSE8:00 AM – 3:00 PM // WED

PARKINSON’S DISEASE COURSE FOR SPEECH LANGUAGE PATHOLOGISTS8:00 AM – 5:00 PM // SAT

Includes lunch, Early Career Networking Reception immediately following. CME/CEU credits are included with this course. MORE: ACRM.org/ecdc

All-day live instruction, lunch, CME / CEUs credits. Non-member registration includes a 6-month introductory membership to ACRM. MORE: ACRM.org/pdfcourse

Special Courses are not included in the WORLD PASS

EARLY CAREER DEV. COURSE

PARKINSON’S DISEASE COURSE FOR SPEECH

LANGUAGE PATHOLOGISTS

Denotes the item is INCLUDED in the WORLD PASS

BEST * R A T E * EARLY BIRD REGULAR ON-SITE

PLEASE SEE THE PRICING WEB PAGE TO VIEW RATE CLOSING DATES:www.ACRM.org/pricing

£ STUDENT / £ RESIDENT / £ FELLOW £CONSUMER & £ EARLY CAREER

MEMBER ¨ 349 ¨ 449 ¨ 499 ¨ 699

NON-MEMBER ¨ 449 ¨ 549 ¨ 599 ¨ 799

EVERYONE ELSE

MEMBER ¨ 399 ¨ 499 ¨ 599 ¨ 799

NON-MEMBER ¨ 499 ¨ 599 ¨ 699 ¨ 899

SPECIAL COURSES

£ COGNITIVE REHABILITATION TRAINING :: Two-day course // MON & TUEINCLUDES Two days of evidence-based training; one printed copy of the ACRM Cognitive Rehabilitation Manual ($150 value); CME/CEU credits; and six months of online access to a previously recorded Cognitive Rehabilitation Training. MORE: ACRM.org/cogatl

£ THE ACADEMY OF CERTIFIED BRAIN INJURY SPECIALISTS (ACBIS) NATIONAL CERTIFICATION PROGRAM :: Two-day course // MON & TUE MORE: ACRM.org/ACBIS

CO

G R

T

& A

CB

IS

This course is included in the WORLD PASS!

This course is included in the WORLD PASS!

ACRM 94th Annual Conference 23 – 28 OCT 2017 ATLANTA USA I N T E R D I S C I P L I N A R YATLANTA HILTON

PROGRESS IN REHABILITATION RESEARCH #PIRR2017

www.ACRM.org T: +1.703.435.5335REG FORM PG 5

BEST * R A T E * EARLY BIRD REGULAR ON-SITE

PLEASE SEE THE PRICING WEB PAGE TO VIEW RATE CLOSING DATES:www.ACRM.org/pricing

WED 25 OCT

RECEPTION I WED EVENING ¨ 0 Please let us know if you plan to attend

THU 26 OCT Please write-in the Luncheon title you wish to attend

LECTURE LUNCHEON W/ SPEAKER: ___________________________ ¨ 69 ¨ 69 ¨ 69 ¨ 69

RECEPTION II THU EVENING ¨ 0 Please let us know if you plan to attend

FRI 27 OCT Please write-in the Luncheon title you wish to attend

LECTURE LUNCHEON W/ SPEAKER: ___________________________ ¨ 69 ¨ 69 ¨ 69 ¨ 69

HENRY B. BETTS AWARDS GALA ¨ 149 ¨ 149 ¨ 149 ¨ 199

GUEST TO GALA ¨ 149 ¨ 149 ¨ 149 ¨ 199

SAT 28 OCT Please write-in the Luncheon title you wish to attend

LECTURE LUNCHEON W/ SPEAKER: ___________________________ ¨ 69 ¨ 69 ¨ 69 ¨ 69

ADDED VALUE OPTIONS

TICKETED EVENTS OPTIONS

These popular events fill quickly. Get your tickets today!

One processing fee covers all CORE conference continuing education credits earned.

Denotes the item is INCLUDED in the WORLD PASS

○ Case Managers (CCMC)

○ Dieticians (CDR)

○ Disability Management Specialists (CDMS Commission)

○ Health Care Executives (ACHE)

○ Licensed Clinical Professional Counselors (NBCC)

○ Nurses (ANCC)

○ Occupational Therapists (American Occupational Therapy Association, Inc.)

○ Physical Therapists (FSBPT; Federated State Boards of Physical Therapy)

○ Physicians and Non MD CME (ACCME)

○ Physician Assistants (ACCME)

○ Psychologists (APA Division 22 Accreditation)

○ Rehabilitative Counselors (CRCC)

○ Social Workers (NASW)

○ Speech-Language Professionals (ASHA)

○ Texas Physical Therapists (Texas Physical Therapy Association)

Entry included with any registration: CORE or WORLD PASS ticket

Entry included with your registration

BEST * R A T E * EARLY BIRD REGULAR ON-SITE

PLEASE SEE THE PRICING WEB PAGE TO VIEW RATE CLOSING DATES:www.ACRM.org/pricing

CME/CEU CREDITS ¨ $149 ¨ $149 ¨ $149 ¨ $149

Consistent with the ACRM commitment to provide high-quality evidence-based educational opportunities to all members of the rehabilitation team, ACRM offers CME/CEU credits in your choice of 15 disciplines.

Please select all that you will be claiming:

CONFERENCE SLIDES

Included in the WORLD PASS, digital access to all available symposia and pre-conference instructional course slide presentations (PDFs) may be purchased separately.

ATTENDING MEMBER ¨ 99 ¨ 99 ¨ 159 ¨ 199

NON-ATTENDING MEMBER ¨ 399 ¨ 499 ¨ 499 ¨ 599

NON-ATTENDING NON-MEMBER ¨ 549 ¨ 649 ¨ 649 ¨ 749

NOTE: Although few content leaders elect not to have their slides available to attendees, some sessions may not be included. Cognitive Rehabilitation Training and Early Career Development Course are not included

ACRM 94th Annual Conference 23 – 28 OCT 2017 ATLANTA USA I N T E R D I S C I P L I N A R YATLANTA HILTON

PROGRESS IN REHABILITATION RESEARCH #PIRR2017

www.ACRM.org T: +1.703.435.5335REG FORM PG 6

STUDENT / RESIDENT / FELLOW: Enrolled in an accredited school of medicine or approved graduate or under graduate program or fellowship in a medical rehabilitation discipline. Current ID required at registration check-in.

EARLY CAREER: Professionals during first five years after completion of post-graduate studies.

REHAB PROFESSIONAL: Professionals in medical rehabilitation or a related field who are actively engaged in the practice, administration, education or research of medical rehabilitation.

CONSUMER / SURVIVOR: Those with disabilities, family and caregivers who use rehabilitation services and/or research.

MEMBER: This category is for active members / professionals in medical rehabilitation or a related field who are actively engaged in the practice, administration, education or research of medical rehabilitation. ACRM members enjoy savings on ACRM products and events, including annual conference registration. Visit www.ACRM.org/join to become a member and start saving.

NON-MEMBER: Non-member registration includes an introductory 6-months ACRM membership, including access to all interdisciplinary special interest groups and networking groups, discount member rates on products and conference registration, and subscription to members-only newsletters.

GROUP RATES: Groups of five or more may email Meganne Furnberg at [email protected] or phone +1.703.435.5335 to learn about special offers that may apply.

SPECIAL CIRCUMSTANCES: ACRM aims to keep the conference registration rates as low as possible so that attending is likely for the greatest number of people – to do the greatest good... getting the QUALITY research that matters to the people who NEED it the most — all in order to IMPROVE the GREATEST number of lives. If your work depends on the research at ACRM to IMPROVE LIVES, you need to be at PIRR. If finances are keeping you from Chicago, ACRM wants to hear from you. Those wishing to attend from lesser developed countries (LDC) and individuals with special financial circumstances, such as unemployment, may email Meganne Furnberg at [email protected] or phone +1.703.435.5335 to learn about special offers that may apply.

CME/CEU CREDITS: Recognizing that not all disciplines require continuing education annually, ACRM offers CME/CEU credits sold separately from conference registration in order to keep the point of entry cost as low as possible. Only those attendees who wish to earn CME/CEU credit will incur this fee. Payment of this single processing fee entitles attendees to all continuing education credits for which they qualify. Consistent with the ACRM commitment to provide high-quality evidence-based educational opportunities to all members of the rehabilitation team, ACRM offers CME/CEU credits in your choice of 15 disciplines, including: 1) Case Manager (CCMC), 2) Dieticians (CDR), 3) Disability Management Specialists (CDMS), 4) Health Care Executives (ACHE),5) Licensed Clinical Professional Counselors (NBCC), 6) Nurses (ANCC), 7) Occupational Therapists (AOTA) 8) Physical Therapists (FSBPT) 9) Physicians and Non MD CME (ACCME), 10) Physician Assistants (ACCME), 11) Psychologists (APA Division 22 Accreditation), 12) Rehabilitative Counselors (CRCC), 13) Social Workers (NASW), 14) Speech-Language Professionals (ASHA), 15) Texas Physical Therapists (Texas Physical Therapy Association).

MEDIA / PR RATE: Members of the media and social media writers relevant to rehabilitation research may contact ACRM for information on press entry and a limited number of potential social media/ PR ambassador opportunities: [email protected].

CANCELLATION POLICY: ACRM is a non-profit organization. Registrants wishing to cancel their existing registration to receive a refund must submit a written request to [email protected]. A cancellation fee of $249 USD will be charged on all cancellations received on or before 31 August 2017. The balance of registration paid will be refunded. On or after 1 September, 2017, a fee of $249 USD or 50 percent of registration paid, whichever is greater, will be charged and any balance refunded. If registration amount paid is less than or equal to $249, no refund will be given. No refunds will be made on or after 1 October 2017. Those who registered as non-members retain their 6-month ACRM membership.

SUBSTITUTIONS / TRANSFERS: The original registrant will be charged a substitution fee of $249 and receive a 6-month ACRM membership.

PHOTO RELEASE POLICY: Attending the ACRM Annual Conference, Progress in Rehabilitation Research, constitutes an agreement by the registrant to permit ACRM to the use and distribute (both now and in the future and with no remuneration to attendee) of the attendee’s image or voice as captured in photographs, videotapes, electronic reproductions and audio files of events attended for any lawful purpose including, but not limited to, illustrating and promoting the conference experience.

PAYMENT: If a credit card payment is declined, the registrant will be notified and an alternative method of payment requested. A $15 USD processing fee will be applied for returned checks and/or rebilling of a credit card. An additional $25 fee will be charged for payment accepted by bank wire transfer.

RATE INFO

TERMS & CONDITIONS

ACRM 94th Annual Conference 23 – 28 OCT 2017 ATLANTA USA I N T E R D I S C I P L I N A R YATLANTA HILTON

PROGRESS IN REHABILITATION RESEARCH #PIRR2017

www.ACRM.org T: +1.703.435.5335REG FORM PG 7

CONFERENCE POLICIES: Recording or photographing conference sessions, panel discussions or sponsor exhibits is strictly prohibited. • Program PDFs and/or recordings will be made available to attendees who have purchased the World Pass or purchased access to these separately. • By registering, you agree not to solicit vendors or exhibitors. • We make our best judgment to assign rooms to the size that we think will match the estimated audience. Every year we try to improve this process. Seating is limited by the size of the rooms, and you are not guaranteed a seat in any session. Seating is first come, first served. Signing up for sessions that interest you in the ACRM app helps us to make sure the more popular sessions are held in the largest rooms to accommodate the most attendees.

SPECIAL NEEDS: We make sure our facility has total accessibility and we do whatever is needed to make attending the event as convenient as possible for all attendees. If you have a special need, please email us: [email protected].

CONFERENCE ETIQUETTE: To make the conference experience an enjoyable event for all attendees, we ask that you please keep the following in mind: • As a courtesy to our speakers and other attendees, please refrain from the use of pagers or cell phones during presentations. Please also keep in mind that participants of this conference are in attendance to learn. In consideration of all attendees we ask that you please take any conversations that are unrelated to the program outside session rooms. • In order to accommodate environmental sensitivities of some attendees, if at all possible, please refrain from or use moderate levels of scented products while attending the conference. • To maintain and demonstrate professionalism within our industry, conference attire is business casual.

BADGES: Registrants are reminded that it is important to wear your badge at all times. This allows you uncomplicated access to conference events.

SMOKING: For the comfort and health of all attendees, smoking is not permitted at any ACRM event. This includes general sessions, workshops, luncheons, receptions, and in the exhibit hall. You may smoke in designated areas located in the conference facilities.

STATEMENT OF LIABILITY WAIVER — TERMS OF REGISTRATION: ACRM or any other conference sponsor claims no liability for the acts of any suppliers at or to the meeting, or for the safety of any registrant while in transit to or from this event. ACRM shall not be liable for any delays or failure in performance or interruption of services resulting directly or indirectly from any cause or circumstance beyond the reasonable control of the organization including but not limited to, acts of God, acts of public enemy, war, accidents, fires, electrical failures, strikes, labor disputes, postal delays, explosions, governmental order or regulations.

ACRM reserves the right to cancel the conference or any function without liability. Registrants who purchased non-refundable airline tickets do so at their own risk. The total amount of any liability of ACRM will be limited to a refund of the registration fee.

Recognizing the nature of receptions and the potential for alcohol abuse at conferences, all ACRM and ACRM sponsored events will offer non-alcoholic drinks. No alcohol will be served to anyone under the age of 21. Conference participants are responsible for their own well-being and neither ACRM or the sponsors will be held accountable for any events or occurrences resulting from excessive drinking, recklessness or negligence on the part of any conference participant(s).

By attending the conference, the registrant agrees to indemnify and hold harmless ACRM, other conference sponsors, their respective officers, directors and agents, against all claims arising out of actions or omissions of supplier, attendee, or other individual at or in connection with the conference except for ACRM’s or any other sponsor’s own gross negligence or willful misconduct.

ACRM or any other conference sponsor reserves the right to substitute an equally qualified speaker in case of an emergency or cancellation.

ACRM or any conference sponsor has no duty of due diligence with respect to presenters, exhibitors, or sponsors, and makes no endorsements of any presentation or product.

Sessions, events and exhibits can only be attended by registered attendees.

No one under the age of 16 will be allowed into the Exhibit Hall.

PLEASE CHECK! ¨ I have read and agree to the Terms & Conditions above and on previous page

ACRM Rehab EXPO Hall will be open to the public on Friday 27 October. Registration required.

ACRM 94th Annual Conference 23 – 28 OCT 2017 ATLANTA USA I N T E R D I S C I P L I N A R YATLANTA HILTON

PROGRESS IN REHABILITATION RESEARCH #PIRR2017

www.ACRM.org T: +1.703.435.5335REG FORM PG 8

Type of Payment Enclosed

¨ Check/Money Order (US Funds Only) Check #__________Make check payable to: ACRM

¨ Credit Card (fill out information below)¨MasterCard ¨Visa ❏ ¨American Express ❏¨Discover

Credit Card #:__________________________________________________

Expiration Date:__________________ Security Code:_______________

Print name as it appears on card:_____________________________________

Cardholder’s Signature: ___________________________________________

Cardholder’s e-mail address: _____________________________________

¨ Check here if you want to bundle ACRM membership/pay your dues renewal too.

$___________TOTAL AMOUNT in USD

DISCOUNT CODE:____________________________________________

< The sum from your selections on the previous pages.

< If a colleague referred you to ACRM, please include their name so we may thank them.

I F A P P L I C A B L E

EMAIL: [email protected] ORFAX: +1.866.692.1619 ORMAIL CHECKS TO: MAIL CREDIT CARD FORMS TO: ACRM: PO BOX 759272 ACRM c/o YPTC, 1500 Walnut St #1200Baltimore, MD 21275-9272 Philadelphia, PA 19102

PAYMENT

BILLING ADDRESS ¨ Check if same as mailing address on pg 1

SUBMIT

Address 1

Address 2

City

State / Province

Zip / Postal Code

Country

Special dietary needs (for ticketed dining events / special accommodations):

How did you hear about this event?

What made you want to attend?

REGISTER NOW!

+1.703.435.5335or visit

ACRM.org

V060617

(to send confirmation)

www.ACRM.org

For questions related to the status of registrations, please contact [email protected] or phone: +1.703.435.5335

Online registration at:

?s

ACRM 94th Annual Conference 23 – 28 OCT 2017 ATLANTA USA I N T E R D I S C I P L I N A R YATLANTA HILTON

PROGRESS IN REHABILITATION RESEARCH #PIRR2017