Conference Registration

National Independent Living Conference
 "Growing Pains"


* indicates required fields

Primary Contact Information - (For invoicing/receipt purposes)

*First Name: *Last Name:  
*City: *State: *Zip:
Country: If you are not in the US
*Phone: Fax:

Attendee Information

Event Name Adults   Price   Youths   Price Ext
Pre-Con and Conference X $390.00 + X $360.00 $0.00
Conference Only X $295.00 + X $265.00 $0.00


*Attendee Name:

To add attendees:

Enter name, title (or chaperone mobile) and email of first attendee, then select the sessions desired. Note: Sessions are not a required field. Providing workshops selections assists in room assignments only and does not guarantee seating. Popular workshops may be crowded, so please arrive early.

After entering data, click the "Add Attendee" button. This will add the first attendee to your list. Repeat steps for each attendee that you are registering.

To edit an attendee's information, click on the attendee you want to edit from the table of attendees. Edit the attendee's information and click "Add Attendee" to update their information.

To remove an attendee, click on the attendee you want to remove from the table of attendees and click "Remove Selected Attendee"

Attendee Title:
(or chaperone cell #)
Attendee Email:
*Shirt Size:
*Conference Selection:
Pre-conference Session:
Session A:
Session B:
Session C:
Session D:
Session E:
Session F:
Attendee(s) Name Title Shirt A/Y PreCon A B C D E F PC

Payment Information

If paying by American Express credit card: Submit your registraton(s) by choosing "Purchase Order" as the payment method and entering "AMEX" in the "PO Number" box. After submitting, call 1-800-226-7612 to provide your credit card number.
Total Amount Due: $
*Payment Method:

How did you hear about us?

Is this your first "Growing Pains" conference?     
Is this your first Daniel Memorial Institute conference?    
How did you hear about this conference? (check all that apply)  
Other, please specify  

Transfer/Cancellation policy: Transfer of registration to another person may be done at any time without a fee. Please notify the Conference Coordinator of all changes. All requests for cancellation must be received in writing and postmarked by the following dates to receive a refund. A full refund (less a $50 processing fee) is available through July 30, 2019. A 50 percent refund (less a $50 processing fee) is available through August 13, 2019. No refunds thereafter. Please note if you do not cancel or attend the conference you are still responsible for payment.

Copyright © 2019 Daniel Kids Foundation, Inc.  All Rights Reserved.

eLYK innovation, inc. Jacksonville, Florida - Web Design Company