Learning Disabilities Association of Indiana
42nd Annual Conference
Friday, November 4, 2016, 9 a.m.-3:30 p.m.
Ritz Charles Conference Center, Carmel, Indiana
Home Address: ___________________________________________________________________________
City: _________________________________________ State: ________ Zip Code: ___________________
Telephone: ( ) __________________________E-mail: _______________________________________
Check all that apply to you:
o Teacher: Spec.Ed. o Gen. Ed. o School System: ___________________________________
o Administrator: Special Ed o General Ed. o School System: __________________________
o Student: High Sch. o Postsecondary o School Attending:____________________________
o Service Provider: Type_________________________________ School o Private Practice o
o Family Member or Individual with a disability: LD o ADHD o Other _________________
o Other: __________________________________________________________________________
Circle method of payment: Check Purchase Order Paypal Credit Card at Conf. Approved Scholarship
o All Day $140 Adult, o $70 Student (H.S./College) (includes continental breakfast and lunch,)
o Half Day $70 (9 a.m.-12:15 p.m. w/ continental breakfast; 12:15-3:30 p.m. w/ lunch.)
o Educator Scholarship $70 o Presenter All Day $25 for lunch and conference materials
Breakout Strands: Attendees have a choice of two breakout strands, which are not interchangeable.
Choose your strand:
o Strand 1: Multi-Sensory Reading Instruction Training. This is a day-long training workshop for teachers and parents based on the Orton-Gillingham approach. (Included in this workshop are the Conference Keynote and the lunch activities.) Attendees will receive a certificate of participation. This workshop requires pre-registration.
o Strand 2: Full LDA of Indiana Conference: This is a day-long conference offering fourteen individual sessions from which to choose four, along with morning and luncheon keynotes. Continental breakfast and lunch are included.
Special Accommodations: Vegetarian o Interpreter o Handouts in large print o Other o_____________
Scholarships: A limited number of scholarships are available for family members of individuals with disabilities to attend free of charge and for educators to attend for half price (if their school systems do not pay their registration fees). To apply for a scholarship, send an email to .
Awards: See our website, , for information about LDA’s awards for an outstanding student, educator, and service provider and to submit a nomination. Questions: Awardslda@gmail.com.
Please print and MAIL this registration form with your check, or purchase order to:
LDA Conference, Blumberg Center, Bayh College of Education
University Hall, 401 North 7th Street, Terre Haute, IN 47809
OR: Circle payment by “Paypal” or “Credit Card at Conf” and FAX your registration to (812) 237-8089
or SCAN & EMAIL to email@example.com.
Onsite Registration is available. Please do not mail registrations after October 28, 2016. After that date, please fax, scan&email, or bring registration form with payment to the conference. Lunch is not guaranteed with onsite registration.
For questions, email firstname.lastname@example.org or call Sharon at 317-443-3426.