Registration Options:

Online: www.utahearlychildhoodconference.com Phone number is 801-957-5200 and 801-957-5201 Fax number is 801-957-5328 Email: MillerEvents@slcc.edu

Registration Information:
No refunds will be issued once registered No registrations will be taken at the door Limited seating available, all sessions are first come first serve Please DO NOT bring children to the conference Registration Dates: Feb 11-28 (earlybird) to Mar 1-8 (regular)

Saturday, March 23rd 2012

Cottonwood High School Murray, Utah

Program/Center Name: First Name:_ Home Address: City: Personal Phone: E-mail: Work Phone: (If left blank, confirmation letter will be mailed) State: Zip Code: Last Name:_

Registration Options: Keynote only _____ Full Conference_____ Type of Program (Check All That Apply):

Committee Member/Volunteer
(No Charge) Promotional Code Required: Presenter Promotional Code Required: _________________
Contact Sheila for promotional code assistance @ 801-675-1240

Full Conference Session Options

Please list your top four choices for each session you wish to attend Class descriptions @ www.utahearlychildhoodconference.com

Session 1 -- 10:15am - 11:15am 1 2_ 3_ Session 2 -- 12:15pm - 1:30pm 1 2_ 3_

UAEYC Member Administrator Center Child Care Head Start/Early Head Start Preschool Early Intervention Other

After School Family Child Care Kindergarten Student Primary Grade Student

Session 3 -- 1:45 pm - 3:00pm

2_

3_

Conference Fee: $20.00 Keynote only (no lunch or sessions) $35.00 Early Bird full conf. (w/lunch) Feb 11 - 28 $45.00 Regular full conf. (w/lunch) Mar 1-8

Session 4 2.5 Hour Session-- 12:15pm-3:00pm

If registering for Session 4, please do not register for Session 2 or 3.

2_

3_

Total: $

Please select preconference events on Friday March 22, 2013 you plan to attend (no additional fee). Show registration receipt for entrance. I will not be attending preconference events I plan to attend Night at the Museum event I plan to attend Tours of NAEYC Accredited Programs I plan to attend the Lakeshore Learning Workshop

Payment Options:

Credit Card
Name on Card: Card #: Expiration:

Visa

AMEX

MasterCard

Discover

Check/Money Order (Payable to Salt Lake Community College)

Business Personal Money Order Check Date ______________ Amount: Check #:

Credit Card Billing Address:

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

#: Name:

City: Phone #: Signature:

State:

Zip:

UAEYC may share its mailing lists with NAEYC and conference sponsors, check here to have your name removed

Registration provided by...

Office Use Only Confirmation Sent: Email Mail Fax In Person Registered By: Date:

Participant Planning Survey

Please help us plan the 2014 conference by answering a few questions

1. How many years of paid experience do you have in the field of Early Childhood?
0-3 years 3-5 years 5-10 years 10-20 years 20+ years

2. Type of program you work in. Check all that apply:

Head Start/Early Head Start Government Agency Public health Nonprofit Center Child Care Family Child Care In home preschool Home visiting Infant toddler Preschool Kindergarten Primary Grade Afterschool program Mental Health Child Care Resource & Referral Special Ed./Early Intervention Student Other ______________

3. Current paid work position. Check all that apply: Teaching Assistant Classroom Teacher Administrator Home visitor Support Staff Coach/Mentor Early Intervention Specialist Speech and language Specialist Adult Educator Secondary faculty Postsecondary faculty Public Policy Administrator Advocacy Student

4. Check all professional organizations you are a member of:

Utah Association for the Education of Young Children (UAEYC) Head Start Association Private Family Child Care Association (PFCCA) Utah Private Child Care Association (UPCCA) Utah Education Association (UEA) Utah Association of Child Care Resource and Referral Agencies (UACCRRA) Council for Exceptional Children (CEC) Association for Infant Mental Health (UAIMH) Utah Afterschool Network Other _______________________

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

6. Please select the 3 topics you are most interested in learning more about:
Science, math, engineering, and technology (STEM) Music, movement & dance Language and literacy Nature/outdoors Art and creativity Developmental assessment School readiness Core curriculum or standards Whole child approaches Powerful teacher-child interactions Positive Guidance Supporting the development of "at-risk" children Supporting English language learners Nutrition & cooking Obesity prevention Home visiting Early Intervention Infant/toddler care Family engagement Preventing child maltreatment Cultural competency Communicating with parents and colleagues Community resources Public Policy Teaching, coaching, and mentoring adult learners Leadership Financial management Staff professional development Preventing burnout Other_____________________________________