nd
First Name:
Address:
Last Name:
City: State: Zip:
Phone number: Emergency Contact Name:
Registration begins Friday at 4pm to 9pm. Please register for the session you plan to go to:
☐ Friday ☐ Saturday October 12, ☐ Saturday Dinner ☐ Sunday Morning and Awards Program October 11, 2013 2013
☐ Friday ☐ Saturday Morning
Registration
& Karaoke ☐
Session One ☐
Session Two ☐
Session Three ☐
☐ Saturday Afternoon
Session Four ☐
Session Five ☐
Session Six ☐
Session Seven ☐
☐ Sunday Morning
Session Eight ☐
If you have people who help you at home please register that person, or someone who can help the same way, and bring them to the conference. They do not need to register for sessions even if they go to a session to help you.
I have support at home and will need support while at the convention.
☐
Yes
☐
No
I will bring: Support Person First Name: ___________________________________________
Last Name: ________________________________________________________
Phone: ___________________________________________________________
Your support person will need to pay for any meals while at the convention.
***If no is marked and a lot of support is needed PFN staff will contact the emergency contact to come help you. PFN does not have the staff or ability to provide any personal care or supervision.***

People First of Nebraska, Inc. Annual Convention Schedule
Date
10/13
10/11
10/11
7:30-9:00
Time
5:00pm-7:00pm
7:00pm-8:00pm
Session
Friday October 11, 2013
Breakfast
Registration
Main Welcoming to the 2013 People First of Nebraska, Inc.
Convention
Dance, or karaoke 10/11 8:00pm-10:00pm
10/12
10/12
10/12
7:30am-9:00am
9:00am-10:15am
10:30am-12:30pm
6 pm-7:30 pm
7:30pm-End
Saturday October 12, 2013
Breakfast
Session One
Welcome! Discussion of the conference and upcoming items to be voted on.
Session Two
Brad Muerrens and Lynn Redding – to help members become effective systems advocates, legislative advocacy, telling your personal story
Session Three
Mary Angus – Communication as a Tool for Advancement
12:30pm -1:30pm Lunch Provided
1:30pm-2:45pm Session Four
Sharon daVanport – Autism 101 - Overview of Autism
Session Five
Nebraska Youth Leadership Council (NYLC) – Transition : A Youth
3:00pm-4:15pm
Perspective, a panel presentation to share experience and insights for young people transitioning after high school
Session Six
NE Statewide Independent Living Council (NESILC) – What is independent living, how Centers for Independent Living can help members – an interactive presentation.
Session Seven TBA
Project II would like to make a presentation – A Hero’s Journey, a video, personal stories - - they will submit an outline for their presentation
Banquet Dinner
Dance with a DJ providing music
10/13
10/13
7:30-9:00
9:00am-10:15am
Sunday October 13, 2013
Breakfast
Business meeting
***If no is marked and a lot of support is needed PFN staff will contact the emergency contact to come help you. PFN does not have the staff or ability to provide any personal care or supervision.***

Please choose your registration selection: prices include all room, meals and Banquet.
Plan #1-includes Friday, Saturday and Sunday (4 meals, 2 nights at the hotel)
Non-member
☐
Plan #1 1 person 2 nights plus 4 meals and the dance $269.
☐ Plan #2 2 people 2 nights plus 4 meals and the dance $175
☐ Plan #3 3 people 2 nights plus 4 meals and the dance $144
☐
Plan #4 4 people 2 nights plus 4 meals and the dance $128
$298
$206
$176
$160
****************************************************************************
☐ Plan #5 1 person 1 night plus 4 meals and the dance $175
☐ Plan #6 2 people 1 night plus 4 meals and the dance $128
☐
Plan #7 3 people 1 night plus 4 meals and the dance $113
☐ Plan #8 4 people 1 night plus 4 meals and the dance $105
$202
$160
$144
$133
******************************************************************************
☐ Plan #9 1 person 1 night plus 3 meals and the dance $167
☐ Plan #10 2 people 1 night plus 3 meals and the dance $120
☐
Plan #11 3 people 1 night plus 3 meals and the dance $105
☐ Plan #12 4 people 1 night plus 3 meals and the dance $97
$195
$149
$134
$123
******************************************************************************
☐ Plan #13 Saturday Only (including 3 meals and dance) $75 per person
Non-member
$115
☐ Plan #14 Dinner and Dance ONLY $35 $68
☐ Sessions ONLY (No Meals and No Rooms) $70
Please check any special things you may need to attend the People First of Nebraska, Inc. annual convention.
☐
Wheelchair accessible room
☐
Roll-in shower
☐
Ground Floor
☐ Special Diet ☐ No Dairy ☐ Gluten Free ☐ Low Carbohydrate ☐ Other __________
Additional Needs:
______________________________________________________________________________
***If no is marked and a lot of support is needed PFN staff will contact the emergency contact to come help you. PFN does not have the staff or ability to provide any personal care or supervision.***

Be sure to get the 2013 People First of Nebraska, Inc Tee shirt by choosing the size and number you want now! We will order it just for you! Pre-ordered price $10
Size: ☐ Small ☐ Medium ☐ Large ☐ XL ☐ XXL ☐ XXXL Pre-order Price $10
At the conference the price will be $15
Number of shirts you would like ______ Amount enclosed $________________