2022 CONFERENCE REGISTRATION

Who Should Attend the Conference?
Anyone who cares about, works with, interacts with or provides support for individuals living with dementia should attend this important conference. Living Well with Dementia will bring together the large, diverse dementia community for unique discussions, learning experiences, and networking opportunities. All will gain valuable insights and understanding about dementia and likely new friendships from the conference.
REGISTRATION FEE SCHEDULE

Conference Registration Options

Please mark your selected registration fee.

 Early Bird thru
July 31, 2022		 After July 31, 2022
Full Conference
Discounted Full Conference Rate each for four or more people from the same organization
Accepted Presenter
Person Living with Dementia
Current Care Partner
One-Day Registration

Please indicate which day you are attending:
Each Additional Exhibitor Personnel

Registration Code
If you have received a registration code, please enter your code here . The appropriate price will appear below.

Registration Cancellation Policy – All registration cancellation requests must be made in writing to OPTimum Planning, 424 General Early Drive, Harpers Ferry, WV 25425. There will be a $100.00 processing fee for each refund. No registration refunds will be made after September 5, 2022.

Registrant substitutions may be made without penalty any time prior to the conference. Requests can be submitted to info@OPTPlanning.com or mailed to 424 General Early Drive, Harpers Ferry, WV 25425.

NOTE - Registrants are responsible for cancelling their hotel reservations.

Covid Policy Please check the website https://daanow.org/conference/ for up-to-date information about the conference covid policy.


Please complete one registration form for each person who will attend the conference.
 
REGISTRATION INFORMATION
►Indicates required field
►Email Address:
►Confirm Email:
►First Name:
►Last Name:
►First Name for Conference Badge:
►Organization/Affiliation:
►Title:
►Street Address:
►City:
►State/Canadian Province:
►Zip/Postal Code:
►Country (if other than U.S.):
►Phone Number:

Please check one area below that most applies to you –
Person living with dementia Care partner
Academic/Educator Adult day services
Advocacy entity Assisted living/Personal care home
CCRC Community organizer
Federal agency Home care/Home health care
Memory Café organizer Nursing home/Skilled Care
Researcher Sponsor/Exhibitor
State agency Student
Technology company Other (please list)

Food Accommodation Requests
Vegetarian meal Gluten-free meal
Vegan meal Food Allergies (please list)

Special Needs Requests
Visual limitations Hearing limitations
CONTINUING EDUCATION UNITS
CEUs are included in the cost of the conference. Please let us know which CEUs you will apply for, so that we may provide any special paperwork needed. Each registration includes processing of one individual's CEU application.
CEUs for License / NAB Registration #(s) State(s)
Nurses: RN or LPN
Administrators
Social Workers
OVERNIGHT LODGING ACCOMMODATIONS

Conference registrants will need to make their own overnight lodging accommodations directly with the Crowne Plaza Hotel Downtown Indianapolis or another hotel of their choosing. Overnight lodging is not included in your conference registration fee. A block of rooms is reserved for conference attendees at the Crowne Plaza Hotel Downtown Indianapolis.

To get the $179/night discounted rate you must let the hotel know you are using the group rate code DA2. To reserve by phone, please call (317) 631-2221 or click here.
DONATIONS
We need your support! Our goal is to provide scholarships to as many people living with dementia who can come to the conference as possible. Your scholarship donation is tax deductible and is greatly appreciated no matter the size. Be a Scholarship Supporter and receive a ribbon for your conference badge to recognize your support.
Donation Amount:
REGISTRATION PAYMENT INFORMATION

Payment for the conference can be made by MasterCard, Visa, American Express or U.S. check. If you wish to pay by U.S. check, please complete the form and print it. Please mail the registration form and your check to –

Dementia Action Alliance Conference
424 General Early Drive
Harpers Ferry, WV 25425

Please make checks payable to the Dementia Action Alliance.

The Dementia Action Alliance will not process your registration without full payment.
Total Due:
Please check one:
First Name of Cardholder:
Last Name of Cardholder:
Card Number:
Expiration Date:
Month: Year:
Security Code:
Card Billing Address:
Address:
City:
State:
Zip:
By submitting this form, you are authorizing the Dementia Action Alliance to process your credit card for payment as indicated above.  Please note that conference badges and materials will not be mailed in advance and may be picked up on-site at Conference Registration.


 

If you have questions regarding your registration, please phone 240.481.3758 or e-mail info@OPTPlanning.com.

Photo/Image Release
We use photos for social media and other education and awareness efforts of the Dementia Action Alliance and Dementia Friendly Indiana. Your registration for the conference provides the right for these organizations to use your likeness for such purposes.