ICEA 2016 Registration Form.pub

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 Registration Information
ICEA Annual Conference October 13‐15, 2016 Reaching the Highest Peaks in Evidence Based Practice Renaissance Denver Stapleton Hotel | Denver, Colorado Welcome and General Info Welcome to the 2016 International Childbirth Education Association Conference The International Childbirth Education Association (ICEA ) is a professional organization that supports educators and other health care providers who believe in freedom to make decisions based on knowledge of alternatives in family‐
centered maternity and newborn care. ICEA’s goals are to provide: Training and continuing education programs Quality educational resources Professional certification programs ICEA welcomes childbirth educators, doulas, nurses, parent educators, midwives, breastfeeding educators, physicians, and other maternal/child health professionals to register for the 2016 Conference. NEW CONFERENCE FORMAT NEW for 2016! The ICEA Team is excited to announce a conference format change that allows GREATER FLEXIBILITY for our atten‐
dees. Now there is no need to preregister for specific concurrent sessions, you’ll choose the sessions you like on‐site. We encour‐
age you to sketch out your schedule/options ahead of time, and arrive early to sessions for best results. Please visit www.icea.org for the most updated schedule/session information. GENERAL INFORMATION HOTEL The conference will be held at the Renaissance Denver Stapleton Hotel: 3801 Quebec St, Denver, CO 80207. We’ve secured a special conference rate of $159/night for ICEA attendees. Please call 1 (800) 468‐3571 or click this link to book your room. Be sure to mention “International Childbirth Education Association” to receive the group rate. This rate is available through Monday, September 19, 2016, or until the group block is sold out‐ whichever comes first. CONTINUTING EDUCATION UNITS (CEUs & CERPS) This activity will be submitted to the Utah Nurses Association and Texas Nurses Association for approval to award con‐
tact hours. The UNA and TNA are accredited approvers by the American Nurses Credentialing Center Commission on Accreditation. EXAMINATION The ICEA Childbirth Certification Exam will be given at the conference. Please email ICEA‐Events@icea.org if you are interested in more information on sitting for the exam. CONFERENCE RESOURCE MANUAL Speaker information for both the general session speakers and the breakout sessions speakers will be available as PDFs on the ICEA website prior to the conference dates. Please go to www.icea.org to download/print the information re‐
garding the speakers/sessions you are interested in. General Info Continued BREASTFEEDING INFANTS Breastfeeding infants under three months of age who remain quiet may attend sessions with parents. Most parents find it helpful to bring a support person to watch their babies outside the meeting rooms in between feedings. EXHIBITS The exhibit hall will feature many exciting vendors in the birth and parenting world. To view a complete list of exhibitors, please visit the ICEA website at www.icea.org. TRANSFERS, CANCELLATIONS, & REFUNDS You may transfer your conference registration to another person at any time with written notification from the original attendee. If you must cancel, please see below and notify the ICEA office in writing via email to ICEA‐Events@icea.org. Refund schedule: Cancellation/refund requested in writing by August 15, 2016: refund less a $75 cancellation fee Cancellation/refund requested in writing by September 15, 2016: refund of 50% amount paid Cancellation/refund requested after September 15, 2016 or a "no‐show" is liable for the full registration fee Special circumstances: Refunds may be granted, at the sole discretion of ICEA, if an attendee is unable to attend the conference due to a family death, illness, other extreme circumstances. ICEA must be notified immediately. ICEA retains the right to request a death certificate, physician note, or other information related to the decision. Note that any refund due or granted will be issued as soon as possible and no later than four weeks after the confer‐
ence has concluded. The International Childbirth Education Association is not responsible for events beyond our con‐
trol such as weather conditions, flight cancellations, venue property conditions, prepaid parking, or prepaid tours. No refunds will be given in these situations. UNITED STATES TAX CREDIT United States residents should consult their tax advisors concerning possible deductibility of this offering. VOLUNTEER! Would you like to be more involved with ICEA and the convention? Volunteer opportunities may include being a greeter or announcer for a session. Written instructions will be given to each volunteer and you can volunteer without missing sessions. Check the appropriate box on your registration form to become an ICEA convention volunteer. 2016 Conference Schedule Tuesday, October 11 8 am ‐ 5 pm Preconference Workshops Wednesday, October 12 8 am ‐ 5 pm Preconference Workshops Thursday, October 13 7 ‐ 8 am 8 ‐ 9:15 am 9:45 ‐ 10:45 am 11 am ‐ Noon Noon ‐ 1:15 pm 1:15 ‐ 2:15 pm 2:45 ‐ 3:45 pm 4 ‐ 5:15 pm 6 ‐ 9 pm Breakfast General Session Breakout Sessions Breakout Sessions Lunch Breakout Sessions ICEA Annual Meeting General Session Member Reception Friday, October 14 7 ‐ 8 am 8 ‐ 9:15 am 9:45 ‐ 10:45 am 11 am ‐ Noon Noon ‐ 1 pm 1 ‐ 2 pm 2:15 ‐ 3:15 pm 3:45 ‐ 5 pm 7:30 ‐ 9 pm Breakfast General Session Breakout Sessions ICEA Committee Meetings Lunch Breakout Sessions Breakout Sessions General Session Special Program Saturday, October 15 7 ‐ 8 am 8 ‐ 9:15 am 9:30 ‐ 10:30 am 11 am ‐ Noon Noon ‐ 1 pm 1 ‐ 2:15pm 2:45 ‐ 4 pm 4 ‐ 5:15pm 5:15 ‐ 5:30 pm Breakfast General Session Breakout Sessions Breakout Sessions Lunch General Session General Session General Session Closing Hotel Accommodations Renaissance Denver Stapleton Hotel 3801 Quebec Street Denver, Colorado 80207 United States of America Call 303.399.7500 for reservations. The ICEA group rate of $159 is valid until September 19, 2016. Schedule subject to change‐ for most current times, please visit www.icea.org. DENVER | OCT 13‐15 Join Us You may also complete your registration online at www.icea.org
2016 CONFERENCE & ANNUAL MEETING REGISTRATION FORM 
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REGISTRATION INCLUDES A wide variety of education sessions Breakfast, refreshments, and lunch daily Entrance to all receptions hosted by ICEA Admission to the Exhibit Hall Time for networking with colleagues & industry partners Registrations must be postmarked or faxed by midnight, Eastern Standard Time (United States) in order to receive the Early Bird and Standard registration rates. Please print clearly and keep a copy of the completed form for your records. This information will be used for your name badge, confer‐
ence mailings, and the participant list. NAME [AS IT WILL APPEAR ON THE NAME BADGE]: LAST _______________________________ FIRST ____________________________ CREDENTIALS [PLEASE LIMIT TO 3] ________________________________________ ICEA MEMBER? ___YES ___NO ORGANIZATION [FOR NAME BADGE] ______________________________________ EMAIL ADDRESS _____________________________ MAILING ADDRESS ________________________________________________________________________________________________ CITY _______________________________________ STATE/PROVINCE __________________________ ZIP/POSTAL CODE ____________ COUNTRY ___________________________________ PRIMARY TELEPHONE _________________________ FAX __________________ CONFERENCE REGSITRATION FEES FULL CONFERENCE: 13‐15 OCTOBER 2016 Early Bird Regular Late by May 15 by Sept. 15 after Sept. 15 ICEA Member { } US$425 { } US$525 { } US$625 Non‐Member** { } US$550 { } US$650 { } US$750 Full‐Time Student* { } US$400 { } US$500 { } US$600 Military* { } US$400 { } US$500 { } US$600 PAYMENT INFORMATION Full Conference Registration US$_____________ Daily Rate Registration: ___days at US$ ______= US$_____________ Additional Options, Total: US$_____________ TOTAL FEE ENCLOSED US$_____________ PAYMENT METHOD { } check { } Visa { } MasterCard Credit Card # __________________________ Exp. Date ____ /_____ Signature _________________________________ CVV ___________ *Please note that these special rates apply to ICEA members only. Appropriate documentation is required. **Non‐Member rate includes one year of membership. If you wish to opt out of Checks must be drawn on a US bank account and made payable to ICEA. Pur‐
chase orders are not accepted. No registrations will be processed by telephone this membership, please check here { } There is no change in rate. or without full payment. ICEA is not responsible for any exchange fees. DAILY RATE Check the day(s) you will attend: { } Thursday { } Friday { )Saturday OTHER INFORMATION (CHECK ALL THAT APPLY) Early Bird Regular Late by May 15 by Sept. 15 after Sept. 15 ICEA Member Non‐Member { } US$175 { } US$225 { } US$225 { } US$275 { } US$275 { } US$325 PRE‐CONFERENCE WORKSHOPS: 11‐12 OCTOBER 2016 Please indicate your choice: { } US$200 Professional Child Birth Education (2 days, 16 hours) { } US$200 Doula & Labor Support Training (2 days, 16 hours) { } US$200 Postpartum Doula (2 days, 16 hours) { } US$200 Early Lactation Care Specialist Workshop (1.5 days, 12 hours) { } US$150 Tools for Success Parts 1&2 (or individually below‐ each 4hours) { } US$100 Part 1 Developing Exciting Curriculum { } US$100 Part 2 PowerPoint‐ Creativity, Productivity, Professionalism { } I would like to volunteer at the conference. { } This is my first ICEA conference. { } Do not include my name on the Conference Participant list. { } I require special conference meals: [ ] vegetarian [ ] vegan [ ] kosher [ ] gluten free [ ] other ___________________________________________ { } I have a physical challenge for which I will need assistance during the conference. Please specify ____________________________________ ICEA Polo Shirt $30 ‐ please indicate (unisex) size: { } Small { } Medium { } Large { } Extra Large Orders for shirts must be received no later than Aug. 31 to allow time for production. REGISTER ONLINE AT WWW.ICEA.ORG Media Disclaimer: ICEA will photograph conference events. By registering for the conference, you grant ICEA permission to record, photograph, use, and distribute (both now and in the future) your image, name and voice in all forms and all media pertaining to this conference. Cancellation and Refund Policy: All conference cancellations/refund requests must be submit‐
ted in writing August 15, 2016 for a full refund less a $75 cancellation fee, by September 15, 2016 for a refund of 50% amount paid. All requests made after September 15, 2016 or "no‐
shows" are liable for the full registration fee. Substitution Policy: Delegates may send a substitute in their place in lieu of requesting a refund, upon prior notification to ICEA. Special Circumstances: Refunds may be granted, at the sole discretion of ICEA, if an attendee is unable to attend the conference due to a family death, illness, other extreme circum‐
stances. ICEA must be notified immediately. ICEA retains the right to request a death certificate, physician note, or other information related to the decision. Dates to Remember May 15, 2016 August 15, 2016 September 15, 2016 September 19, 2016 September 26, 2016 October 13‐15, 2016 Early Bird Registration Closes Deadline to Cancel Registration for a Full Refund (less admin fee) Regular Registration Deadline Hotel Registration Deadline Pre‐registration Deadline (otherwise, proceed onsite for staff assistance) ICEA 2016 Conference NEED HELP? info@icea.org ‐ general questions, membership, or certification icea‐events@icea.org ‐ conference‐related questions International Childbirth Education Association 2501 Aerial Center Parkway, Ste. 103 Morrisville, NC 27560 www.icea.org 
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