First Name: 

Last Name: 

Affiliation: 

E-mail: 

Daytime Phone: 

Do you need child care in order to attend the conference?

Yes. The name(s) and age(s) of the child/children I will likely bring to the conference are:

No, I do not need child care.

¿Usted necesita
servicios de traducción
en español simultáneo?

Yes

No

We all wear multiple hats, but would you say that your interest in this conference is primarily because you are (check one):

• a parent
• an early childhood educator
• manage/administer a child care agency
• a K-12 teacher
• a K-12 administrator
• a community college or university educator
• a student
• a researcher
• an early childhood advocate
• a government staffer or elected official
• other:

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