2022 AZSCIA Push Forward Conference Registration
** All precautions per CDC Mandates will be in place. Social distancing will be in place.  We will also have hand sanitizer available.***

Please register below for the AZSCIA Push Forward Conference on Friday October 7th,, 2022 at:
Desert Willow Conference Center
4340 East Cotton Center Boulevard
Phoenix, Arizona 85040
8AM to 4PM

Cost:
        Consumers and either 1 Caregiver or 1 Family Member: Free to attend
        Additional Family Members or Caregivers: $40.00
        Professionals and Students: $40.00   We will have CEU’s available. Please note below if you need them.
           Once you hit submit, you will see the link to pay on Square. Thank you.

We will provide transportation to/from Ability360 to Desert Willow. Vans will leave Ability360 by 8:15AM so please arrive by 8:00AM to allow time for loading. Vans will return to Ability360 at 4:30pm. If you need other arrangements, please call the office- 602-507-4209.

**If you require a caregiver, please make arrangements to bring someone with you to help you during the day.
 Caregivers will be able to attend all classes with you,  We will not be responsible for your care.**
Thank you for understanding.  We look forward to seeing you all there!
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First Name *
Last Name *
Email *
So we can send you a reminder as the day gets closer. Thank you!
Phone Number *
In case we need to contact you. Thank you!
*
Consumer
Caregiver
Family Member
Professional
Student
I am a :
Do you need transportation from/to Ability360? *
If you are a student/professional, will you be needing CEU's? A certificate of attendance will be sent out after the conference.
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I would like to be a volunteer the day of the event
Will you need any special accommodations, besides a caregiver? If so, please explain below. Thank you.
How did you hear about the conference? *
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Which Rehab or Doctors office did you hear about the conference?
Thank you for signing up for our 2022 Push Forward Conference!              
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