CONFERENCE REGISTRATION FORM – EXTERNAL LIAISON MEMBER
Section on Pediatrics Annual Conference (SoPAC) 2015
November 6-8, 2015 * Pittsburgh, PA
(Preconference Courses November 4-5, 2015)
The Section on Pediatrics of the American Physical Therapy Association has member liaisons to a number of external
organizations to share information; identify topics of mutual concern; and work toward the common goal of providing
the highest quality physical therapy services to children, their families, and adults with developmental disabilities. These
relationships are above and beyond those liaison relationships established by APTA. These organizations are: Association
of People with Severe Handicaps (TASH); Council for Exceptional Children (CEC); Division of Early Childhood (DEC);
United Cerebral Palsy (UCP); National Education Association (NEA); IDEA Partnership; National Joint Committee on the
Communication Needs of Persons with Severe Handicaps (NJC); Autism Society (ASA); American Academy for Cerebral
Palsy and Developmental Medicine (AACPDM); Sarah Jane Brain Project/National Pediatric Acquired Brain Injury Plan
(PABI); National Coalition on Personnel Shortages in Special Education & Related Services (NCPSSERS); Office of Special
Education Programs/National Early Childhood Technical Assistance Center (OSEP-NECTAC); American Association on
Intellectual and Developmental Disabilities (AAIDD); Special Olympics; and National Center on Birth Defects &
Developmental Disabilities, Center for Disease Control and Prevention Learn the Signs, Act Early Campaign.
If you are a member of one of these partner organizations, the Section on Pediatrics will extend the discounted Section
on Pediatrics member rate to you to attend SoPAC. To receive this special discount, please complete the information
below and mail in this form to the address indicated.
Have you attended SoPAC before? Yes No
Member Organization Name: __________________________ Member Number in Your Organization:___________
Name/Credentials: ______________________________________________________________________________
Nickname for Badge_____________________________________________________________________________
Address: ______________________________________________________________________________________
Daytime Phone: ___________________________ E-mail:_______________________________________________
General SoPAC Registration (November 6-8) - 18 contact hours
Member Type
External Liaison Organization
Member Rate
Early-Bird
(Ends Aug 1)
$440
Advance
(Ends Oct
15)
$485
Onsite
(Begins Nov 4)
Advance Daily
(Ends Oct 15)
Onsite Daily
(Begins Nov 4)
$535
$220
$250
If attending for a single day, please indicate which day you will attend:
____ November 6 (5 contact hours)
____ November 7 (7 contact hours)
____ November 8 (6 contact hours)
Preconference Course Registration (optional, November 4-5) – contact hours as marked
Select
Course
Preconference Courses (8:30
am – 5:30 pm)
2-Day Course (15 contact hours,
Nov 4&5): APTA Advanced
Clinical Instructor Credentialing*
6/16/15
Advance for SoPAC
participant
(Ends Oct 15)
$100 (APTA
member)
$225 (non-APTA
member)
Advance for nonSoPAC participant
(Ends Oct 15)
same
Onsite
(Begins Nov 4)
N/A
2-Day Course (15 contact hours,
Nov 4&5): Therapeutic Taping
1-Day Course (7.5 contact hours,
Nov 5): Splinting the High-Risk
Infant in the NICU and Beyond
1/2-Day Course (3.25 contact
hours, Nov 5): Fabrication of
Temporary Foot Supports: A
Hands-on Lab
$450 including
materials
$300 including
materials
$490 including
materials
$340 including
materials
$525 including
materials
$370 including
materials
$175 including
materials
$205 including
materials
$245 including
materials
*If you will be attending the APTA Advanced Clinical Instructor Credentialing preconference course, please download and submit the ACCIP
Attendee Dossier (posted at www.sopac.us) to pediatrics@apta.org; the dossier must be submitted no later than October 15.
Optional Social Events
Attend optional Welcome Reception* on Thursday, November 5, 6:00 pm-8:00
pm. Attendance is complimentary, but you must indicate if you plan to attend, so
we can include you on the registration list.
Attend optional Dinner at the Andy Warhol Museum on Saturday, November 7,
7:00 pm-10:00 pm. The cost to attend is $50 and requires advance registration.
 Check if attending
__ Number attending
__ Number attending
Total $____________
*There is also be an optional football game on Saturday; tickets are purchased directly from vendor. More info at www.sopac.us.
Order Summary
ITEM
SoPAC Registration Fee
Preconference Course Registration Fee
Optional Social Events
TOTAL AGREEMENT AMOUNT
COST
_____Vegetarian?
_____Gluten Free?
_____Special needs? (Please specify:_______________________________________________)
Please let us know how you heard about SoPAC: SOP website/newsletters
Postcard in the Mail Ad in Advance
Other: ______________________________________________________________________________________
Payment: You can register by mail by sending in this registration form with your check to:
Section on Pediatrics, APTA
Attn: Component Registrar, SoPAC 2015
1055 North Fairfax St, Suite 205
Alexandria, VA 22314-1488
Checks should be made payable to: Section on Pediatrics, APTA. This registration form must be received with payment
in full and must be postmarked by Early-Bird or Advance deadline dates indicated above in order to receive that rate.
Refund Policy: The Section reserves the right to cancel this event, in which case all monies paid will be reimbursed. If
you need to cancel your registration, please send a request in writing to the above address by October 6, and allow 4
weeks for reimbursement (minus a $100 processing fee). No refunds will be allowed after this date.
Note: Attendance for this course is limited and will be handled on a first-come, first-served basis.
6/16/15