SOFT Conference Registration - Trisomy 18, Trisomy 13

SOFT (USA) ONLINE REGISTRATION - STEP 1

* Please fill in all required elements

PERSONAL DETAILS

SOFT Member #

*Last Name:

*E-mail Address:

*Phone:

*Street Address:

*City:

*State/Province:

*ZIP/Postal:

*Country:

TRAVEL DETAILS

Travel Mode: Arrival Date: Time: Departure Date: Time:

First-time attendee?

*Please indicate if your SOFT child will eat conference meals:

*Baseball Game Transportation Needs:

Bus Seats

Wheelchair(s) Positions

*Picnic/Balloon Celebration Transportation Needs

Bus Seats

Wheelchair(s) Positions

Please Indicate Number of people attending Chapter Chair Luncheon: (Chapter Chairs or Prospective Chapter Chairs Only)

ATTENDEE INFORMATION

* Attendees			Sibling Outings		Child Care (Pre-registration required)
Badge Name (First & Last)	Child Age	Type*	(Age 4-11) T-shirt Size	(12+ yrs)	Thurs PM Clinics ONLY	Friday AM	Friday PM	Friday Eve

* Registration Type: A=Adult, S=SOFT Child, C=Child 12 yrs. and younger, P= Professional

CLINICS

We will need transportation for the Thursday Clinics to The Sanford Children's Hospital for people and wheelchairs.
Childcare is available at the hotel for siblings. Please indicate above the number of siblings who will stay at the hotel for childcare.

Identify 4 choices of clinics (with #1=most important, #4=least important)

#	Clinic	#	Clinic	#	Clinic	#	Clinic
	Cardiology		Genetic Counseling		Orthopedics		Pulmonary
	Developmental Pediatrics		GI/Feeding		Palliative Care
	Ear/Nose/Throat		Neurology		Physiatry/Rehab

WORKSHOPS

Thursday and Friday Workshop Pre-registration:
Please indicate how many people from your family will attend the following workshops.
If you are requesting a Certificate of Attendance, please provide name(s) for the certificate:

Thursday Afternoon Workshops, July 15th		Thursday Afternoon Workshops, July 15th
# Attending	Session 1 – 1:00 – 2:30pm	# Attending	Session 2 – 2:40 – 4:00pm
	A) Grief Support and Making Memories		A) Knitting Therapy

Friday Morning Workshops, July 16th		Friday Afternoon Workshops, July 16th
# Attending	Session 3 – 9:15 – 10:30 am	# Attending	Session 5 – 1:30 - 2:45 pm
	A) Trisomy 18		A) Financial Estate Planning
	B) Making Partners with Your Professional		B) Ethical Issues/Decision Making
	C) What About Me, the Sibling?		C) My Child is Getting Older, So What Should I Expect Now?
	D) Related Disorders and Periantal Concerns		D) TRIS Project - Eating Issues

Friday Morning Workshops, July 16th		Friday Afternoon Workshops, July 16th
# Attending	Session 4 – 10:45 am - NOON	# Attending	Session 6 – 3:00 – 4:15 pm
	A) Trisomy 13		A) Moms' Roundtable - Moms Only
	B) Making Partners with Your Professional		B) Working with the Family Physician
	C) What About Me, the Sibling?		C) Music Therapy
	D) Accessing Special Education Services		D) Caring for the Caregiver
			E) "Dads, a Beer, and Straight Talk" - Dads Only

Ryan Cantrell Balloon Release Celebration Information

The annual balloon release will be held during the picnic on Saturday afternoon, July 17, 2010. You need not be in attendance to have a balloon released for a child who has passed. Fill out and return the following information, and we will ensure that a balloon is released for your child.

Child’s Name:

Date of Birth:

Date of Death:

Disorder:

Your Name:

Relationship:

Address:

City:

State/Province:

ZIP/Postal:

Phone Number:

SOFT-wear ORDER FORM

We will have the following items for sale at the conference. Help us avoid disappointing you by ordering early so that we can place our orders and have the items you want.

Type	XS 2-4	S 6-8	M 10-12	L 14-16	XL (18-20)		Total	Price (each)	Cost
Youth T-shirt, SS							0	$10.00	$0.00
	S	M	L	XL	XXL	XXXL
Adult T-shirt, SS							0	$12.00	$0.00
Adult T-shirt, SS							0	$14.00	$0.00
Total

WELCOME DINNER INFORMATION

There will be a special menu for children 12 and under. For those over 12, please indicate your menu choice:

	#		#
Children 12 & Under:		Herb & Garlic Encrusted Prime Rib:
Chicken Chardonnay:		Vegetarian Pasta Alfredo:

CONFERENCE COST COMPUTATION

* The picnic cost is included for full conference attendees

* Attendees	#	Cost (each)	Total Cost
Current SOFT members: Full Conference Adults & Children 13 & over (Includes Picnic)		*$110.00	0.00
Non-SOFT members: Full Conference Adults & Children 13 & over (Includes Picnic)		$135.00	0.00
SOFT 1-year family membership ($25US, $35 all other countries, multiple years welcome)		$25.00	0.00
Full Conference SOFT Children and siblings 2 and under (Includes Picnic)		FREE	0.00
Full Conference Children (3 – 12 years old) (Includes Picnic)		*$85.00	0.00
Friday Sibling Outing (4 – 11)		$16.00	0.00
Friday Sibling Outing (12 and up)		$15.00	0.00
Picnic* Only (Saturday afternoon): Adults & Children 13 & over		*$25.00	0.00
Picnic* Only (Saturday afternoon): Children 12 & under		*$15.00	0.00
Optional Sioux Falls Pheasants Baseball Outing (Friday Night)		$9.00	0.00
Registration Late Fee, Adults only (Postmarked after June 5, 2010)		$25.00	0.00
SOFT-wear (from above)			$0.00
Donation to the Joey Watson Memorial Fund
A contribution for the 2010 Conference will be appreciated
Donation to SOFT National (Any donations are appreciated)
	(Grand Total)		$0.00

Comments

Registration questions? Contact Kim & Gloria Jorgenson at 605-947-4752 kgjorg@abe.midco.net
or Robin Krommendyk at 605-271-1384 kromm@sio.midco.net

For More Information, see: www.trisomy.org

Remember! You must make your own hotel reservations with the Holiday Inn City Centre. For the SOFT group rate reserve
by June 12, 2010: (605) 339-2000. Make sure to make known any special needs you might have.