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Event Registration


EVENT REGISTRATION FORM
Please fill out all appropriate information and scroll down to submit.

Event Name:
Event Date:
Contact Information:
Name:
Address:
City:
State:
Zip:
Phone:
E-mail:
Check to be added to the mailing list
Check to be added to the email list
Race/ethnicity
(optional):
Number of Adults Attending
Number of Children Attending Ages 3 - 12
Number of Children Attending Ages Under 3

Professional Information:
Professional?
Check if yes
Agency/School District

Caregiver Information:
Individual with disability? Check if yes
Caregiver of a special needs child? Check if yes
If yes, age of child
Child’s disability

Photo Disclaimer

By checking this box I hereby grant permission to the Exceptional Family Resource Center (EFRC) to use my photograph on its website or in other EFRC publications without further consideration, and I acknowledge EFRC's right to crop or treat the photograph at its discretion. I also acknowledge that EFRC may choose not to use my photo at this time, but may do so at its own discretion at a later date. I also understand that once my image is posted on the EFRC website, the image can be downloaded by any computer user. Therefore, I agree to indemnify and hold harmless from any claims the Exceptional Family Resource Center.

 

You doy permiso al Centro de Recursos para Familias Excepcionales (EFRC) de usar mi fotografía en su Sitio en la Red de Internet o en sus publicaciones oficiales sin mayor consideración y reconozco el derecho de EFRC a recortar o tratar la fotografía a su discreción. Yo también reconozco que EFRC pudiera decidir usar mi foto en este momento, pero puede hacerlo a su propia discreción en una fecha posterior.


Yo también entiendo que una vez mi imagen es publicada en el sitio Internet de EFRC, la imagen puede ser copiada por cualquier usuario de una computadora. Por lo tanto, yo estoy de acuerdo con indemnizar y mantener inofensivo por cualquier reclamación al Centro de Recursos para Familias Excepcionales.


* Registration deadline is generally 1 week prior to event so that materials may be assembled for attendees. You will receive a confirmation phone call or email message. If you do not, please call 800.281.8252.

 

 


Exceptional Family Resource Center
9245 Sky Park Court, Suite 130 - San Diego CA 92123