Developmental Disabilities Day at the Legislature
Wednesday, February 10, 2016
8:00 AM – 1:00 PM
Registration Form
Print Name (First, M.I., Last)
Address
City
State
Phone
Zip Code
Fax
E-MAIL
Would you like to be added to the sponsoring organizations E-Newsletter Mailing List?
Is this your first time attending the DD Day?
YES
YES
NO
NO
Check all that apply:
Self-Advocate
Family Member
Government Personnel or Official
Professional
Other
Cost for Developmental Disabilities Day at the Legislature is $18.00 per person
Registration deadline is February 4, 2016
PAYMENT INFORMATION
____On-line Payment with PayPal at www.thearcmd.org
____My check or money order is enclosed and made payable to The Arc of Maryland.
____I authorize The Arc to collect my registration fee through
Circle One:
Visa
MasterCard
Credit Card No.:_______________________________________
Exp. Date: ____________________
Name as it appears on credit card:________________________
3-digit code:___________________
Authorized Signature:__________________________________
Mail or Fax (410-974-6021) to:
The Arc of Maryland
Attn: DD Day Registration
130 Lubrano Drive, Suite 212
Annapolis, MD 21401
410-571-9320
About our Hotel Location
Loews Annapolis Hotel
126 West Street
Annapolis, MD 21401
410-295-3259