Registration Options: Online: www.utahearlychildhoodconference.com Phone: 888-665-1369 or 801-505-5256 Mail: 2483 Gilmour. West Haven, UT 84401 Email: uaeyc.mail@gmail.

ail.com Registration Information: No registrations will be taken at the door. No refunds will be issued once registration is completed. Session changes can be made online through March 8, 2014. Early Bird Registration dates On or Before 2/28/2014. Regular Registration dates 3/1/2014 - 3/8/2014. Name changes can be made through March 8th via email to help@orchideventsolutions.com. Name changes may incur a $25.00 processing fee. Please DO NOT bring children to the conference.

Saturday, March 22, 2014

Weber State University Ogden, Utah

Please register early since there is limited seating available and all sessions are first come first serve basis. The registration deadline is March 8, 2014. All registrants will receive a registration confirmation via email. First Name:_ Program/Center Name: Mailing Address: City: Personal Phone: E-mail:
A boxed lunch is included and comes with a sandwich, fruit, bag of chips, brownie, and drink. Please select sandwich preference: Gluten Free Turkey Ham Dairy Free No lunch Veggie Please select community events on Friday March 21 you plan to attend (no additional fee). Show registration receipt for entrance. not attending community events Treehouse Museum (Friday 10 am 8:30) Tours of Early Childhood Programs (Friday 103:00) Will you need a shuttle from the Union Station Frontrunner to campus? morning shuttle 8:00 - 9:15 am afternoon shuttle 4:15 - 5:15 pm I will not be using the shuttle

Last Name:_ _________________________ State: _________ Zip Code:

UAEYC may share its mailing lists with NAEYC and conference sponsors, check to remove your name from the list

________ Work Phone: ____________________________ (If left blank, confirmation letter will be mailed) Registration Options: Full Conference Session Options Please list your top four choices for each session you wish to attend
Class descriptions (link to pdf file here) www.utahearlychildhoodconference.com

Session 1 -- 10:45am - noon 1 2_ 3_ Session 2 -- 1:15pm - 2:30pm 1 2_ 3_

Session 3 -- 2:45 pm - 4:00pm 1_______2_________3________4________

Demographic Questions Please help us plan the 2015 conference- The 40th Anniversary- by answering a few questions 1. Years of paid experience in Early Childhood? 0-3 years 3-5 years 5-10 years 10-20 years 20+ years 2. Years of education completed? less than high school graduation high school graduate some college associate degree bachelor degree graduate degree 4. Current paid work position. Check all that apply: Other Administrator Adult Educator Advocacy Classroom Teacher Coach/Mentor Student Family Provider Home Visitor Early Intervention Specialist Postsecondary Faculty Public Policy Administrator Secondary Faculty Speech and Language Specialist Teaching Assistant

3. Type of program. Check all that apply: Other Afterschool Program Child Care Resource & Referral Center Child Care Family Child Care Government Agency Head Start/Early Head Start Home Visiting Infant Toddler In Home Preschool Kindergarten Mental Health Nonprofit Preschool Primary Grade Public Health Special Ed./Early Intervention Student

5. Professional organization membership? Check all that apply: Other Council for Exceptional Children (CEC) Head Start Association National/Utah Association for the Education of Young Children (NAEYC/UAEYC) Professional Family Child Care Association (PFCCA) Utah Association of Child Care Resource and Referral Agencies (UACCRRA) Association for Infant Mental Health (UAIMH) Utah Afterschool Network Utah Education Association (UEA) Utah Private Child Care Association (UPCCA) Council for Exceptional Children (CEC) Head Start Association National/Utah Association for the Education of Young Children (NAEYC/UAEYC) Professional Family Child Care Association (PFCCA) Utah Association of Child Care Resource and Referral Agencies (UACCRRA) Association for Infant Mental Health (UAIMH) Utah Afterschool Network Utah Education Association (UEA) Utah Private Child Care Association (UPCCA)

6. How did you hear about the conference? Check all that apply: Other Colleague Email Flyers Newsletter Postcard Website Workplace

7. Do you have access to the internet? Yes No

9. What format would you prefer for your conference certificate? Paper Online pdf file

8. What format would you prefer for completing participant conference evaluations? Online survey Paper and pencil Facebook Text

10. Please help us plan the 2014 conference by selecting the 3 topics you are most interested in: Other Art and Creativity Core Curriculum or Standards Communicating with Parents and Colleagues Community Resources Early Intervention English Language Learners Family Engagement Health, Nutrition, Obesity Prevention Home Visiting Infant/Toddler Care Leadership and Administration Language and Literacy Music, movement & dance Nature/Outdoors Observation and Assessment Public Policy Social Emotional & Mental Health Stress and Preventing Burnout Science, Math, Engineering, and Technology (STEM) Teaching, Coaching, and Mentoring Adult Learners 11. Suggest a 2015 Keynote: __________________________

Payment Options:
$40.00 Early Bird full conf. (w/lunch) Feb 10 - 28 $55.00 Regular full conf. (w/lunch) Mar1-8 $1 processing fee (per name badge) Presenter/volunteer Promotional Code ________

Credit Card Name on Card: Card #: Expiration:

Visa MasterCard Discover

Check/Money Order (Payable to UAEYC) Business Personal Money Order Check Date ______________ Check #: Amount:

Credit Card Billing Address: City: Phone #: Signature: State: Zip:

Purchase Order Company: Attn: Phone: Address: City:

#:

State:

Zip:

Confirmation Sent: Email Mail Registered By:

Office Use Only

Date: