QCDD: Sign Up

Please use this form to sign-up for upcoming events.

Benefits of registering:
Conference FREE for consumers, families, parents and caregivers

Note:
Agency Professionals must pre-register. Include a $20 registration fee for each professional
made payable to the
Queens Council on Developmental Disabilities.
Certificates of Attendance available on request.

Agency/Company Name:

First Name:

Last Name:

Additional Names:

Address:

City:

State:

Zip Code:

Email:

Home Phone:

Work Phone:

Interpretation Needed?

Yes

What Language?

Pre-register me for the Autism Mini-Conference

Please Indicate:

I heard about the conference from:

I am a professional
I am a parent
I am a state official
I am a city representative
I am a state representative
I am a federal representative