Individual Registration Note: Please submit one registration form per attendee. CONTACT INFORMATION Full Name: Job Title: Company: Parent Company: Address: City, State, Zip: Phone: Fax: Email Address* (required): RCFE Admin Certificate #: ADDITIONAL INFORMATION Tell Us About Yourself Please check all that apply: 1st time attendeeVegetarian How did you hear about the conference? (check all that apply) Conference BrochureCALA News & ViewsCALA UpdateCALA WebsiteColleagueOther How long have you worked in the Assisted Living field? 2 years or less3-5 years5-10 years10+ years Please rank your top three reasons (1-3) for attending this conference (number one being most important) Continuing Education Meeting with Assisted Living professionals outside of your company Meeting with colleagues within your company Support of CALA Other: CONFERENCE RATES Please select only one. 1st Member Full: $585Two Days: $450One Day: $335 Additional Member Full: $495Two Days: $385One Day: $285 1st Non-Member Full: $925Two Days: $710One Day: $535 Additional Non-Member Full: $770Two Days: $590One Day: $445 Student** Full: $205Two Days: $160One Day: $120 **intended for students looking to start or advance in senior living, as opposed to established professionals - verification of student status required. Early Bird discount does not apply to student registrations. One or Two Day Attendees (If you are attending the full conference, skip this part.) Two Days: Monday & TuesdayTuesday & Wednesday One Day: MondayTuesdayWednesday PAYMENT Registration Fee (one attendee): Early Bird Discount (-$30): *Early Bird payment must be received by September 22, 2017 and does not apply to student registrations. Grand Total: PAYMENT METHOD CheckCredit Card (Visa, MC, Amex) Cardholder Name: Credit Card Number: Expiration Date: If opting to pay by check, please mail to: CALA, 455 Capitol Mall, Ste 222, Sacramento, CA 95814. Confirmation – You will receive written confirmation of your registration from CALA within 10 days of receipt. Non-Members – CALA memberships are companywide. If you are not a member, please pay the non-member rates, or join CALA to receive member rates. Conference Discounts – CALA must receive your registration and payment by September 22, 2017 for the early bird discount. As the student rate is deeply discounted, the early bird discount does not apply to student registrations. Attendee Roster – CALA must receive your registration no later than October 14, 2017 to be listed in the official pre-registered roster, which will be available on-site. Cancellation Policy – Cancellations received in writing by 5:00 p.m. 11 business days before the event will receive a refund less a $50 administrative charge. Cancellations received 6 -10 business days before the event are not refundable (regardless of registration date), but credit may be given for future CALA educational offerings; substitute attendees are encouraged. No refunds or credits will be given for cancellations received thereafter. No-shows will be billed. Remittance – Payment and registration can be mailed or faxed to CALA, 455 Capitol Mall, Suite 222, Sacramento, CA 95814, Fax (916) 448-1659. On-site CALA Photographer – Please be advised that a CALA photographer will be taking photos at the conference. As a registered participant, you agree to be included in photographs that may be used for future publicity or marketing materials. CALA Contact - All registered attendees agree to receive CALA correspondence via fax, e-mail or phone. Please call 916-448-1900 if you require special accessibility or accommodations at this function.