Annual Conference Application THE KENTUCKY OCCUPATIONAL THERAPY ASSOCIATION Occupational Therapy: Helping those in Kentucky achieve "Living life to its fullest" September 19th and 20th, 2008 Pre-Conference Sessions September 18th Western Baptist Hospital 2401 Kentucky Avenue Paducah, KY 42001

PERSONAL INFORMATION

Last Name:      First Name:

  Address:

     City:     State:      Zip:

Contact Phone:

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(Conference confirmation will be sent to this email)

Organization/Facility:

Registration Fee Table

Type	Member	Non-Member	Student Member	Student Non-Member
2 Day Conference
OT/OTA	$175.00	$275.00	$30.00	$150.00
2 Day Early Registration (due 8/31)
OT/OTA	$157.50	$247.50	$27.00	$135.00
1 Day Only
OT/OTA	$100.00	$200.00	$15.00	$100.00
Other Rates
Consumer	$25.00	Daily rate, no continuing education credit given, includes Rehab Techs

If attending for one day only, please indicate which day: 9/19     9/20

PAYMENT INFORMATION

Conference Registration Fee: (Use the above lookup table to determine your fee)	$ 0.00 15.00 25.00 30.00 27.00 135.00 100.00 150.00 157.50 175.00 200.00 247.50 275.00
PRE-CONFERENCE SEMINARS (9/18)
Ken Flowers, RPT, CHT: Evaluation and Treatment of the Upper Extremity $100 for members, $200 for nonmembers, $30 student members, $100 student non-member	$ 0.00 30.00 100.00 200.00
PRE-CONFERENCE SEMINAR: Susan B. Young, OTD, MA, OTR, FAOTA:Intervention Strategies Using a Sensory Integration FOR $100 for members, $200 for nonmembers, $30 student members, $100 student non-member	$ 0.00 30.00 100.00 200.00
Total Amount to Charge:	$

(MasterCard or Visa accepted)

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Expiration Date (month/year):

Billing Address is same as Above

Address:

     City:     State:     Zip:

Conference Hotel: Drury Inn and Suites; Reservations: 270-443-3313 ; say KOTA for conference rate $77 (does not include taxes).
To reserve online, go to www.druryhotels.com, click on Book it Fast, then enter group number 2036418 or call 1-800-325-0720 to make your individual group reservations. Please specify the Hotel location and reference your Group Name.

There are no charges to attend the annual business meeting and the auction. Checks should be made out to KOTA. *KOTA offers reciprocity for members in other State associations to attend the Conference at member rates; Presenters get a 10% discount for conference; No shared registration; or substitutions. Cancellations must be submitted in writing; $25.00 charge for cancellations; Questions: call KOTA at 1.888.987.5682, or email: rhondatedwards@prodigy.net; register online at www.kotaweb.org.