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REGISTRATION FORM
Presented by
WYNDHAM NEW YORKER HOTEL — APRIL 22–24, 2015 WWW.YOUNGCHILDEXPO.COM
MAIL OR FAX COMPLETED FORM & PAYMENT TO: Los Niños Training, 535 8th Avenue, 2nd Floor, New York, NY 10018
If paying by check, make check payable to Los Niños Training
CONFERENCE FEES
(Check Appropriate Fee)
Early Bird Special (3/23/15)
Regular Professional Rate
Group (3–10 people)/Student/Parent
1 DAY
(Check ONE day) o $150.00 o W o Th o Fri
o $200.00
o $125.00
TELEPHONE: 212-787-9700 ext. 333 FAX: 212-787-4418
2 DAY (Check TWO days)
3 DAY
o $250.00 o W/Th o W/Fri o Th/Fri
o $300.00
o $225.00
o $350.00
o $400.00
o $325.00
*Group rates available for 11 people or more—please call or go to www.youngchildexpo.com for more details.
FULL DAY PRE-CONFERENCE WORKSHOPS _______________________
YOU HAVE THE OPTION TO ATTEND EITHER DAY (MON OR TUES) OR BOTH DAYS.
Special Registration Fee: $175 early bird per workshop. After early bird
(3/23/15) it is $225. This workshop fee is independent of any conference fee. You
may register for this workshop instead of, or in addition to, the conference.
Name*________________________________________________________________________
Address* ______________________________________________________________________
Each FULL DAY Session is offered for .7 ASHA CEUs, 8.0 TYPE II BACB
CEUs, and 7 NASP CPD credits upon completing the activity.
City*_______________________________________State*____________ Zip*______________
MONDAY 4/2O: Advanced Topics in Behavior Analysis and the
Treatment of Children with Autism (Part 1) Vincent J. Carbone, EdD, BCBA-D
Work Phone*_________________________ Home Phone_______________________________
o Yes, I will attend this FULL DAY Workshop, Monday 4/20 (8:30a.m.–4:30p.m.)
TUESDAY 4/21: Advanced Topics in Behavior Analysis and the
Treatment of Children with Autism (Part 2) Vincent J. Carbone, EdD, BCBA-D
Cell Phone_____________________________________________________________________
o Yes, I will attend this FULL DAY Workshop, Tuesday 4/21 (8:30a.m.–4:30p.m.)
E-MAIL*_______________________________________________________________________
MONDAY 4/2O & TUESDAY 4/21: Advanced Topics in Behavior
Analysis and the Treatment of Children with Autism (Part 1 & 2)
Vincent J. Carbone, EdD, BCBA-D
Occupation*___________________________________________________________________
Special Registration Fee: $300 early bird per workshop. After early bird
(3/23/15) it is $400. This workshop fee is independent of any conference fee. You
may register for this workshop instead of, or in addition to, the conference.
Company or Organization*______________________________________________________
o Yes, I will attend this TWO DAY FULL DAY Workshops, Monday 4/20 & Tuesday
4/21 (8:30a.m.–4:30p.m.)
Position in Company*___________________________________________________________
HALF DAY PRE-CONFERENCE WORKSHOPS _______________________
Check Payment: Make check payable to Los Niños Training. (See address above)
Special Registration Fee: $85 early bird per workshop. After early bird
(3/23/15) it is $115. This workshop fee is independent of any conference fee. You
may register for this workshop instead of, or in addition to, the conference.
TUESDAY 4/21: Learn the Biting Solution: Become an Expert on
Solving Habitual Biting Problems Lisa Poelle, MA
o Yes, I will attend this HALF DAY Workshop Tuesday 4/21 (9:00a.m.–12:00p.m.)
TUESDAY 4/21: Nature Play Every Day: How Zoo Educators Have ReImagined Science Education for Young Audiences Using Theater Arts,
Play, and Youth-Directed Inquiry Bricken Sparacino, Program Coordinator
Credit Card Payment (check one): o Visa o MasterCard o AMEX o Discover
Card Number__________________________________________________________________
Exp. Date__________________________ 3 or 4 digit verification code___________________
Name of Cardholder:___________________________________________________________
o Yes, I will attend this HALF DAY Workshop Tuesday 4/21 (9:00a.m.–12:00p.m.)
TUESDAY 4/21: Learn and Move Together to the Sights and
Sounds of Writing: Effectively Use Music and Movement to
Teach Handwriting Skills Michele Parkins, MS, OTR & Carrie Davis, MS, OTR
(3 NASP CPD credits upon completing this activity)
o Yes, I will attend this HALF DAY Workshop Tuesday 4/21 (9:00a.m.–12:00p.m.)
TUESDAY 4/21: Physiologic, Motor, Sensory and Behavioral Aspects
of Picky Eating and Feeding Disorders Melanie Potock, MA, CCC-SLP
(.3 ASHA CEUs upon completing this activity)
o Yes, I will attend this HALF DAY Workshop Tuesday 4/21 (1:00p.m.–4:00p.m.)
TUESDAY 4/21: Moving Beyond, “Calm Down!” Building a
Toolbox of Effective Emotion Regulation Strategies for Children
and Adults Shauna Tominey, PhD
(3 NASP CPD credits upon completing this activity)
o Yes, I will attend this HALF DAY Workshop Tuesday 4/21 (1:00p.m.–4:00p.m.)
TUESDAY 4/21: The Special Needs Child in Your Classroom:
Activities for Successful Integration Monica Levy, Director
o Yes, I will attend this HALF DAY Workshop Tuesday 4/21 (1:00p.m.–4:00p.m.)
Total Payment for Young Child Expo & Conference___________
Billing Address (if different from above address)
Address_______________________________________________________________________
City*_______________________________________State*____________ Zip*______________
* Required Information
Register online, by fax, or by mail. Confirmations are made by e-mail only. Your
registration will be confirmed once full payment is received. Please contact us immediately
if you do not receive confirmation within 2 business days of registration.
Cancellation Policy. A Full refund will be given if Los Niños Training is notified in writing by
Wednesday, April 1, less an administrative fee of $15. No refunds will be extended after April 1.
Seating is general admission on a first come first served basis.
Young Child Expo does not guarantee attendance at specific sessions,
except for the full day workshops for preregistrants.
Contact: Nancy Evangelista, Conference Coordinator, MSW
212-787-9700 ext. 333, www.youngchildexpo.com