2019 CONFERENCE REGISTRATION

Who Should Attend the Conference?
Individuals who are living with dementia symptoms and anyone who cares about, works with, interacts with or provides support for them should attend this important conferenceRe-Imagining Dementia will bring together the diverse dementia community for collective discussions, interactions and learning experiences.  All will gain valuable insights and understanding from the conference.

REGISTRATION FEE SCHEDULE

Conference Registration Options

Please mark your selected registration fee.

Early Bird thru
April 15, 2019
After April 15, 2019
Pre-Conference Dementia Intensive on Thurs, June 20th with Dr. Al Power
Full Conference
Accepted Presenter
Person Living with Dementia*
Care Partner
One-Day Registration

Please indicate which day you are attending:
Each Additional Exhibitor Personnel
Volunteering One-Day, Conference One-Day

* If you are a person living with dementia and would like to be considered for a conference scholarship, please contact Karen Love at karenlove4@verizon.net.

Registration Code
If you have received a registration code, please enter your code here . The appropriate price will appear below.

Registration Cancellation Policy – All registration cancellation requests must be made in writing to 424 General Early Drive, Harpers Ferry, WV 25425.  There will be a $100.00 processing fee for each refund.  No registration refunds will be made after June 6, 2019.

Participant substitutions may be made without penalty any time prior to the conference. Requests may be submitted to registrar@OPTPlanning.com, faxed to 304-566-9911 or mailed to 424 General Early Drive, Harpers Ferry, WV 25425.

NOTE - Registrants are responsible for cancelling their hotel reservations.


Please complete one registration form for each person who will attend the conference.
 

REGISTRATION INFORMATION
Indicates required field
Email Address:
Confirm Email:
First Name:
Last Name:
First Name for Conference Badge:
Organization/Affiliation:
Title:
Street Address:
City:
State/Canadian Province:
Zip/Postal Code:
Country (if other than U.S.):
Phone Number:

Please check one area below that most applies to you –
Person living with dementia Care partner
Academic/Educator Adult day services
Advocacy entity Assisted living/Personal care home
CCRC Community organizer
Federal agency Home care/Home health care
Memory Café organizer Nursing home/Skilled Care
Researcher Sponsor/Exhibitor
State agency Student
Technology company Other (please list)

Food Accommodation Requests
Vegetarian meal Gluten-free meal
Vegan meal Food Allergies (please list)

Special Needs Requests
Visual limitations Hearing limitations

Special Interest Areas
Which area best describes your interest -
Enhancing Life with Dementia thru Technology Changing the Status Quo
Engaging Local Communities in Dementia Inclusivity Nurturing Creative Expressions through the Arts
Optimizing the Well-Being of Individual Living with Dementia Promoting Ways to Support Care Partners' Well-Being
CONTINUING EDUCATION UNITS
CEUs are included in the cost of the conference. Please let us know which CEUs you will apply for, so that we may provide any special paperwork needed. Each registration includes processing of one individual's CEU application.
CEUs for License / NAB Registration #(s) State(s)
Nurses: RN or LPN
Administrators
Social Workers
OVERNIGHT LODGING ACCOMMODATIONS

Conference participants will need to make their own overnight lodging accommodations directly with the Westin Buckhead Atlanta or another hotel of their choosing. Overnight lodging is not included in your conference registration fee. A block of rooms is reserved for conference attendees at the Westin Buckhead Atlanta under the name "The Dementia Action Alliance" until May 28, 2019. To reserve by phone, please call 800.253.1397.

Westin Buckhead Atlanta
3391 Peachtree Road, N.E.
Atlanta, GA 30326
Reservations: 800.253.1307

REGISTRATION PAYMENT INFORMATION

Payment for the conference can be made by MasterCard, Visa, American Express or U.S. check. If you wish to pay by U.S. check, please complete the form and print it. Please mail the registration form and your check to –

Dementia Action Alliance Conference
424 General Early Drive
Harpers Ferry, WV 25425

Please make checks payable to the Dementia Action Alliance.

The Dementia Action Alliance will not process your registration without full payment.

Total Due:
Please check one:
First Name of Cardholder:
Last Name of Cardholder:
Card Number:
Expiration Date: Month: (mm) Year: (yy)
Security Code:
Card Billing Address:
Address:
City:
State:
Zip:
By submitting this form, you are authorizing the Dementia Action Alliance to process your credit card for payment as indicated above.  Please note that conference badges and materials will not be mailed in advance and may be picked up on-site at Conference Registration.


 

If you have questions regarding your registration, please phone 681-252-3570 or e-mail registrar@OPTPlanning.com.

Photo Release
We use photos for social media and other awareness efforts of the Dementia Action Alliance. Your registration for the conference provides the Dementia Action Alliance the right to use your likeness for such materials.