2024 Building CAPACD Convention Registration Form

To register for the 2024 Building CAPACD Convention, please complete the fields below. If you are registering multiple attendees, each attendee will need to be registered separately, with their own email address. If you run into any issues while completing this form, please contact us at events@nationalcapacd.org.

Attendee Information

First Name

Last Name

Pronouns

Other Pronouns

Organization Full Name

Organization Abbreviation

Job Title

If you are a student or a non-profit, please register with your .edu or .org email

Mobile Phone

Work Phone

Work Mailing Street

Work Mailing City

Work Mailing State

Work Mailing Zip

National CAPACD Affiliation (select all that applies)

If other affiliation, please specify:

COVID-19 Policy Adherence

Please select one of the following options:

I am fully vaccinated and have received at least one booster for COVID-19 at least 2 weeks prior to June 10, 2024. I will submit proof of my latest vaccination and booster information when requested.I am requesting a medical or religious accommodation to the COVID-19 vaccine and booster requirement. I understand that National CAPACD staff will be contacting me and that my registration is conditional upon review.

Additional Information

Food Restrictions/Allergies: Please note if you have any dietary restrictions or food allergies that we should be aware of. (Any designated restrictions or allergies will be accommodated at each meal)

Childcare: Will you require child care services during the Building CAPACD Convention official programming hours? (If you do require childcare, we will reach out to you)

YesNoMaybe

Pursuant to the Americans with Disabilities Act, do you require specific aids or services?

i.e. Large print documents, mobility accommodations, etc.

Is there any other support we can provide for you to create an inclusive environment at the 2024 Building CAPACD Convention?

I.e. interpretation services

Media Consent: Can we use your photos and video images?

I DO NOT consent to the use, publication, or republication of photos, videos, images, or audio in which I may be included.I consent to the use, publication, or republication of photos, videos, images or audio in which I may be included.

Payment

How will you pay for your ticket?

Check by Mail

Please remit via check to:

National CAPACD

1025 Connecticut Avenue NW Suite 1017
Washington DC 20036

Please note that your registration is not complete until payment has been received.

Billing Information

Billing Address Line 1

Billing Address Line 2

Billing City

Billing Postal Code

Billing Country

Billing State

Billing Provinces

Payment Information

Name on Card

Card Number

Code

Billing Email