Annual Conference Application THE KENTUCKY OCCUPATIONAL THERAPY ASSOCIATION Occupational Therapy: Helping those in Kentucky achieve "Living in a Time of Change" September 17th, 18th and 19th, 2009 Pre-Conference Sessions September 17th Jenny Wiley State Resort Park 75 Theatre Court Prestonburg, KY 41653-9799 800-325-0083

PERSONAL INFORMATION

Last Name:      First Name:

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     City:     State:      Zip:

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(Conference confirmation will be sent to this email)

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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: 9/18     9/19

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 (9/17)
Testing Stroke Recovery: An Introduction to Practical Outcome Measures Peter G Levine co-director of the Neuromotor Recovery and Rehabilitation Laboratory Department of Rehabilitation Sciences, University of Cincinnati Academic Medical Center in Cincinnati, OH Leah S. Dunn MS, OTR/L $100 for members, $200 for nonmembers, $30 student members, $100 student non-member	$ 0.00 30.00 100.00 200.00
PRE-CONFERENCE SEMINAR: Examining the Evidence in Pediatric Practice Colleen Schneck, ScD, OTR/L, FAOTA Sharon Brandenburger Shasby, EdD, OTR/L, FAOTA $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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Billing Address is same as Above

Address:

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Conference Hotel:
Rooms are available at the May Lodge at Jenny Wiley State park.  
Rates for Rooms:   
single 76.46 Fri and Sat.  
double 67.46 Sun-Thurs                        
double 76.46 Fri and Sat  
Each Additional Adult after 2 is 10.00   Cottages are available for a non-discounted rate.   Only a portion of the rooms are reserved at this price so make your reservations early to get this rate. You must mention "KOTA Conference" when reserving a room.

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: Rick Parker ricky@maysvilleky.net  ; register online at www.kotaweb.org.