Missouri Assistive Technology

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Power-Up 2011 - Attendee Registration Form

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In order to receive the attendee early registration discount, a completed registration form must be returned to Missouri Assistive Technology by February 23, 2011 , along with payment. Deadline for all registrations is April 1, 2011.

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Conference Fee: (covers all conference activities including Intensives & Sessions, Keynotes, Expo, Monday Evening Reception, Tuesday Continental Breakfast and Luncheon)

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         $125   Early Registration Conference & Expo fee received by February 23, 2011          
     $150   Registration received after February 23 for two days
     Registration fee for One Day Only Monday   Tuesday  $80 for either day

Call for Credit Card payment option.

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Mail, Email, or Fax, Registration Form, & Make Checks payable to:

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Missouri Assistive Technology
1501 NW Jefferson St., Blue Springs, MO 64015
Fax: (816)655-6710 Email: brenda.whitlock@att.net

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If registering with a Purchase Order,(non-state agencies) put P.O. number here:
If you are a State Agency, put customer "I" number here:
Cancellation/Refund:  Refunds will only be given if written cancellation notice is received via mail, fax or email by April 1, 2011.

*State agencies must send in registration form first, do not initiate payment, MoAT will initiate the Inter-Agency Billing (IAB). Call with questions. Thank you.

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Contact Information:
Brenda, Voice: (816) 655-6700, TTY: (816) 655-6711, FAX: (816) 655-6710
Email: brenda.whitlock@att.net
Visit www.at.mo.gov for updated info and any session changes.
Alternative format available upon request.

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Note:*If you do not receive an email confirmation within two business days, we did not receive this form. If you receive an error message after submitting this form, navigate back to this page and print the completed form locally. Email, Mail or fax the form to the above.

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