2023 IDA Austin Conference Registration Form with payment by Check or PO

Date(Required)

Name(Required)

First Last

Email(Required)

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

IDA Member?(Required)

I am an IDA Member

I am Not an IDA Member

I am a student

Member Number

How did you hear about the conference?

What is your primary interest?

Teacher

Administrator

Parent

Tutor

Psychologist

Person with dyslexia/ learning disability

Other

IDA Member Conference Ticket

(Lunch and snacks are included in your registration.) Cancellation/Refund Deadline (minus a $25 cancellation fee): January 21, 2023 (After that date, no refunds will be issued.) Your registration is transferable to another participant. However. If you must transfer your registration, please contact IDA Austin at 515-666-8190 or aabida.mb@gmail.com.

Price:

Non IDA Member Conference Ticket

Price:

Student Ticket

Price:

Do you have any dietary restrictions?

Consent(Required)

I agree to the privacy policy.

**Cancellation and Postponement Policy: In the event of inclement weather or unforeseen circumstances, IDA Austin will attempt to reschedule.

**By submitting this form, you’re consenting to receive marketing emails from: IDA Austin, PO Box 92604, Austin, TX 78709. You can revoke your consent to receive emails at any time by using the SafeUnsubscribeTM link, found at the bottom of every email.

COVID-19 DISCLAIMER

COVID-19 has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.

IDA Austin put in place preventative measures to reduce the risk of spreading COVID-19 at its events and activities, including suggesting masks and having hand sanitizer readily available. However, IDA Austin cannot guarantee that you will not become infected with COVID-19 by attending and/or participating in its events. Attending and/or participating in IDA Austin’s events during the COVID-19 pandemic could expose you to someone who has been infected with COVID-19 and increase your risk of contracting COVID-19.

By participating in any IDA Austin events, you: (1) acknowledge the contagious nature of COVID-19; (2) voluntarily assume all risk that you may be exposed to or infected by COVID-19; and (3) agree to release, covenant not to sue, discharge and hold harmless Dallas IDA and its officers, employees, agents, and representatives from any and all claims arising out of or

related to exposure to COVID-19, including but not limited to claims for personal injury, illness, disability, death, economic loss, and expenses of any kind.

IDA Austin respectfully asks you not to participate in any of our in-person events if you are showing symptoms of COVID-19 (cough, shortness of breath, fever, chills, muscle pain, headaches, sore throat, loss of taste or smell).

Total

PO Number