Online registration form

Print out PDF file (click here) or Word document.

Complete and mail to the address below.

1.     If paying by purchase order, you may register online and include the purchase order number where indicated.  You will then receive an e-mail with your registration information included. 

Please check the registration information on the message then forward the entire e-mail (with any corrections indicated) to whiteheadbarbaraa@uams.edu.  You will then receive a second e-mail message confirming your registration.

2.     If paying by check or money order, you may complete the registration form online. You will then receive an e-mail with your registration information included.  Please check the registration information on the message, make any corrections and print the e-mail and include it with your payment and mail to the address below.  You must include a printed copy of your registration form when you mail your payment so the payment will be applied to the correct registration form.  Your registration is not completed until payment is received.   

3.     If paying by check or money order, you may also choose to download the registration form complete it and mail it with your payment to the address below.
 

We accept checks, money orders and purchase orders.  Checks and money orders should be made payable to: UAMS Welcome the Children.  We apologize for any inconvenience, but we are unable to accept cash or credit cards.  

Mail Completed Registration Form and Payment To:

UAMS Welcome the Children Institute

ATTN: Barbara Whitehead

Partners for Inclusive Communities

2001 Pershing Circle, Suite 300

North Little Rock, AR 72114
 

To ensure that you are included in the number for the luncheon and brunch, you must register by November 5, 2009.  On-site registration is not available.   For the best rate, register by August 31, 2009!

If you register but are unable to attend the Institute, you may allow someone else to attend in your place provided that you notify us in advance of the Institute date.  If you need to cancel your registration entirely, your cancellation request must be received in writing (e-mail, fax or regular mail) by November 5, 2009, in order to receive a refund of your registration costs.  No refunds will be made for cancellations received after November 5, 2009.  If you do not receive a confirmation of your cancellation request by noon, November 6th, please e-mail Barbara Whitehead at whiteheadbarbaraa@uams.edu or call her at 501-682-9900 (V); 501-682-9902 (TDD); 800-342-2923 (V/TDD).

Please contact: Brenda Reynolds reynoldsbrendak@uams.edu; Darlene Kurtz, kurtzdarlenej@uams.edu; or Sabrina Zarco, zarcosabrinae@uams.edu; 501-682-9900; 1-800-342-2923 (V/TDD); 501-682-9902 (TDD)
 

We are committed to providing program access for persons with disabilities to insure full participation.  This is accomplished by holding meetings and conferences in accessible locations and through the provision of auxiliary aids and services (i.e. interpreters, adapted materials).  Persons with disabilities who require auxiliary aids and services, please notify Judy Young at youngjuditha@uams.edu; 501-682-9900 (V); 1-800-342-2923 (V/TDD); 501-682-9902 (TDD) at least one month prior to the conference to insure appropriate accommodations.