BIAA – Maine 2019 Conference Exhibit/Sponsor Additional Personnel Registration (in addition to those included with exhibit registration)

Registration for Additional Exhibit Personnel for Sponsors/Exhibitors at the 10th Annual Conference on Defining Moments in Brain Injury in Portland, Maine.

First Name of Sponsor/Exhibit Representative*

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Last Name of Sponsor/Exhibit Representative*

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Title of Sponsor/Exhibit Representative*

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Organization Name*

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E-mail of Sponsor/Exhibit Representative*

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Phone of Sponsor/Exhibit Representative*

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Address Type (select Work or Home)*

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Street Address*

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City*

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State*

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Zip*

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9:30 - 10:30 Session Selection (Required, Select One)*

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12:55 - 1:55 Session Selection (Required, Select One)*

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2:20 - 3:20 Session Selection (Required, Select One)*

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3:30 - 4:30 Session Selection (Required, Select One)*

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ADA Accommodations Request (Optional)

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If you have a disability covered by the Americans with Disabilities Act (ADA) and would like to request an accommodation, please specify the request here.

Dietary Needs Request (Optional)

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Please indicate any dietary needs/special meal requests here.

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Additional Sponsor/Exhibitor Representative Registration for the 10th Annual Conference on Defining Moments in Brain Injury presented by BIAA-Maine. Please register the first (exhibitors) or first and second (sponsors) exhibit personnel using the BIAA-Maine 2019 Conference Exhibit Personnel Primary Registration option to receive the registration(s) included with the sponsorship or exhibit.

When: October 19, 2019 from 7:30 a.m. to 4:30 p.m.

Where: Abromson Center, University of Southern Maine, Portland, Maine

ADA Accommodation Request: If you have a disability covered by the Americans with Disabilities Act and would like to request an accommodation, please indicate it in the space provided.

Dietary Needs Request: Please indicate any dietary needs/special meal requests in the space provided.

Conference Brochure (coming soon): Download the conference brochure

Conference Session Selection: Please indicate which sessions you are most interested in attending by selecting the dropdown next to each session title. This will help us to put the most desired sessions in the largest meeting rooms and does not guarantee you space in any session. If you decide later that you would like to attend a different session than you've selected, you may do so; there is no need to notify BIAA-Maine of the change.

Continuing Education Credits:

Certified Brain Injury Specialists (CBIS/CBIST): The Academy of Certified Brain Injury Specialists will recognize up to five hours of Continuing Education credit for attendance at the full conference for renewal of Certified Brain Injury Specialist and Certified Brain Injury Specialist Trainer certifications.

Psychologists: Please contact Lori Sandefur for information at maineconferences@biausa.org

Physicians: Applications will be submitted for Continuing Medical Education Credits.

Social Workers: An application is pending with the NASW Maine Chapter.

Nurses: Nurses will receive a Certificate of Attendance for six contact hours.

For more information: For questions regarding continuing education credit, please contact Lori Sandefur at maineconferences@biausa.org

*Indicates a Required Field