Registration – C4A/CFILC Virtual Conference Platform

Register to Attend

Registration is required to attend and participate in the workshop sessions. Please note: You will receive a Lobby code closer to the event. The Lobby area will be used to navigate the break out sessions.

The registration fee is $59 per attendee. The conference begins at 9 a.m. (PDT) on Thursday, October 7, 2021.
Click the appropriate registration button below to begin your registration.

Standard Payment Registration

Promo Code Registration

Registration Form

Your Full Name

What is your organization's association? (Check all that apply).
Independent Living CenterAAAADRCOther

Please list your association.

Check your Aging & Disability Resource Connection (ADRC) affiliation.
I am with a designated ADRCI am with an emerging ADRCI am not associated with an ADRC

Best phone number to reach you:

Your Email

Organization Information

Title

Organization/Company

Street Address

City

State

Postal Code

Let's #ContinueTheConversation

How has the pandemic impacted the mental health of you and your team?

What are your self care strategies?

What resources have you found most helpful during the pandemic?

*Please note: Your answers will be used anonymously on a PowerPoint slide displayed throughout the conference and social media.

Payment and Accommodation Information

Please indicate how many people you are registering (including yourself):
x $59

*Please note: We cannot accept combination paid/promo code registrations through this same form. If you have a promo code please use the Promo Code Registration Form to register separately.

Please enter the email addresses for each individual you are registering. When the primary registrant receives the lobby code, they will be responsible for distributing the code to their own group.

All video streams will be captioned. Check any additional reasonable accommodations required for you (or your group).
ASLAudio DescriptionElectronic Materials In AdvancedOther

If other, please list your reasonable accommodation.

How would you like to pay?

Once you submit your info, please refer to your confirmation email for check payment instructions.

I'll be using a credit card NOT under my own name.

For verification purposes, please type the name as it appears on the credit card you will be using.

Once you submit your info, you will be redirected to our Credit Card processing page.

Please only click once. The revolving icon means the form is processing.
By clicking "Submit Info" you agree to receive periodic marketing emails related to the disability community.

Promo Code Registration Form

Your Full Name

What is your organization's association? (Check all that apply).
Independent Living CenterAAAADRCOther

Please list your association.

Check your Aging & Disability Resource Connection (ADRC) affiliation.
I am with a designated ADRCI am with an emerging ADRCI am not associated with an ADRC

Best phone number to reach you:

Your Email

Organization Info

Title

Organization/Company

Street Address

City

State

Postal Code

Let's #ContinueTheConversation

How has the pandemic impacted the mental health of you and your team?

What are your self care strategies?

What resources have you found most helpful during the pandemic?

*Please note: Your answers will be used anonymously on a PowerPoint slide displayed throughout the conference and social media.

Accommodation and Promo Code Information

All video streams will be captioned. Check any additional reasonable accommodations required for you.
ASLAudio DescriptionElectronic Materials In AdvancedOther

If other, please list your reasonable accommodation.

Please indicate the type of promo code you will be using:

*Please note: Each promo code registration should be done separately.

Please enter the scholarship code below:
Promo Code:

Please enter the complimentary code you were provided by CFILC/C4A staff below:
Promo Code:

Please only click once. The revolving icon means the form is processing.
By clicking "Submit Info" you agree to receive periodic marketing emails related to the disability community.

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#CAComingTogether
#ContinuingTheConversation
#BehavioralHealth

Please email IntegratedConfHELP@gmail.com if you have questions, need assistance or have a comment about the conference.