July 18—21, 2019 DoubleTree by Hilton Hotel Portland

1000 NE Multnomah St., Portland, OR 97232

5p– Society PO Box 268, Lakewood, CA 90714

(888) 970-0777 director@fivepminus.org

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Welcome to Portland! The host families and the 5p– Society invite you to join us in the beautiful city of Portland, Oregon. Portland, known for it’s vast amount of coffeehouses, trendy food spots, Voodoo Doughnuts, wineries, bicycle paths, bridges, mi-crobreweries and best of all no sales tax! It is also a very eco-friendly city and individuals can transport around town on the Max Light Rail, buses, shuttles as well as bicycles, and lots of walking paths. Portland is also known for it’s en-tertainment, love of music, as well as a famous bookstore called Powell’s City of Books, Art Walks and it’s sports teams the Timbers and Trail Blazers. For our adventurous families, plan a day to Mt. Hood, the Oregon Zoo, Portland’s Japanese Gardens, or the Grotto. There is definitely plenty to do and see in Portland.

The host families will be instituting a type of mentoring program where parents who have attended several confer-ences will be asked to buddy up with a new family (or one who has only attended a few conferences) to help with networking and making the newer families feel comfortable, giving them a person to go to to ask questions about what to expect from a conference. This program is not replacing Kent Nicholls New Family Orientation on Thursday evening. Closer to the conference you will be receiving more information about this program and how you can help. Taking this a bit further, we will also be matching siblings who have attended a few conferences with those who have never attended a conference. This too, will assist the sibling in where to go and provide them with a buddy at the conference.

Going green is the eventual goal of the 5p– Society. We will again use the conference app. The app will provide you with the schedule, speaker’s presentation notes, attendees information, as well as allow us to send messages out to families. With the app you will be able to check into a presentation and then evaluate the presentation immediately thereafter. What does this mean for a Conference Booklet? We will be doing away with a large conference booklet, but instead provide a reduced Booklet with specific information, schedule, list of donors and volunteer.

New, this year . . . We plan to have a keynote speaker on Friday morning to get us all going and excited about the conference. We will then have our Parent Breakouts by age followed by a Dad’s Workshop and Mom’s Supportshop. Yes, you heard it right here, Moms, we are going to have our own support group time!! We will then hop on some buses and head to the National Historic Oregon Trail Interpretive Center to learn all about the Oregon Trail and get some hands on activities. Lunch will be served. Grandparents will have their own Supportshop in the afternoon.

Saturday will be loaded with speakers on topics of interest, followed by our banquet and family dance. On Sunday, we will possibly have a guest speaker, learn about the 2020 conference and take some pictures to remember the event by.

Siblings will have a mixer event on Thursday evening, a SibShop on Friday morning and an outing on Saturday to Oaks Amusement Park (lunch and transportation included).

For more information about Portland and things to do check out the link on our website https://fivepminus.org/event/2019-5p-society-annual-conference-portland-oregon/?event_date=2019-07-18.

We can’t wait to meet you all!!

Your 2019 Conference Host Families

Rob & Becky Owens Roger & Angela Borek Tim & Dawn Turner Bill & Christy Blount Ron & Paula Johnson

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Pioneers of the New Frontier Guide

Location: Conference location is at the beautiful DoubleTree by Hilton Portland hotel at 1000 NE Multnomah

St., Portland, OR 97232. There are two room rates. First room rate is $169.00, this is for a single queen room (you can always get a rollaway, or bring sleeping bags), the second room rate is $189.00, this is for either a double double room or a single queen room. Double double rooms are very limited, connecting rooms are very limited. You can ask for a rollaway, crib or bring sleeping bags/inflatables (just don’t tell the hotel!!) You can make your reservations online or by calling the hotel at (503) 281-6111. The online link is: https://doubletree.hilton.com/en/dt/groups/personalized/R/RLLC-DT-5PS-20190714/index.jhtml?WT.mc_id=POG Let the hotel know you are with the 5p– Socie-ty conference. Please note: The hotel is booked before and after the conference for different events and there are very very limited amount of rooms available before or after. If you’d like to come early and stay later you may want to look into a different hotel to stay at for your extended stay. Portland is a very busy place in the summer! Beautiful and busy!

Transportation: If you fly in Portland International Airport (PDX) you can hop on the Max Light Rail https://

trimet.org/max/index.htm#map. You will want to hop on the MAX RED LINE, Lloyd Center/NE 11th Ave MAX sta-tion, Stop ID 8374. This will drop you off at the hotel and takes approximately 30 minutes. As an alternative, you can fly into Seattle’s International Airport also known as SeaTac and either rent a vehicle to drive down to the DoubleTree (approximately 2 1/2 hours), or take the Bolt Bus (https://www.boltbus.com/default.aspx). The Bolt cost approximately $35.00 round trip per person. It can accommodate wheelchairs. It also has plug-in charging for your devices, extra legroom, reserved seating. There is Wifi on board. Trip takes a little over 3 hours to get from the SeaTac to the Doubletree.

Family Event: On Friday afternoon, We will be heading

to the End of the Oregon Trail for a barbecue & Pioneer activi-ties at the Oregon Trail Interpretive Center (https://www.historicoregoncity.org/). Learn more about the Pioneers who trail blazed their way westward in the mid 1800’s. There will be a fee of $3.00 per person to attend the event. Trans-portation included (individuals with 5p– Syndrome are free).

Sibling Outing: On Saturday, siblings only will enjoy an

outing to Oaks Amusement Park. The kids will be transport-ed, enjoy lunch and receive ride wristbands for a day of fun (http://oakspark.com/builder/projects/template/). Volunteers welcomed.

Kid care: Children and adults with 5p– Syndrome and their siblings are welcome to check into Kid Care. There

will be five rooms (divided by age) with volunteers (family and friends) watching and entertaining the kids while parents attend the various sessions on Friday morning and Saturday morning/afternoon (you will need to pick them up during lunchtime and re-check them in after lunch on Saturday). Please create an account with KidCheck (www.kidcheck.com), a software check-in/check-out program that we will use at the conference. More info will be sent with your confirmation packet. KidCheck allows you to create profiles about your children to assist us with learning more about them and their specific needs. Volunteers welcomed.

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Registration Information We have changed registration this year. Online registration opens March 1, 2019.

Family Registration link for members: https://5psociety.regfox.com/2019-5p-annual-conference—member-registration

Family Registration link for non-members: https://5psociety.regfox.com/2019-5p-annual-conference—non-member-registration

Single Registration link for members: https://5psociety.regfox.com/2019-5p-annual-conference---member-individual-registration

Single Registration link for non-members: https://5psociety.regfox.com/2019-5p-annual-conference-non-member-individual-registration

Early bird registration by July 1, 2019

Single registrants will be $100.00. Single registrations only, no additional individuals can be added to your regis-tration.

Family member registration will be $200.00 for up to four individuals (any ages). Additional individuals will be$50.00 per person (all ages).

Non-members registration will be $250.00 for up to four individuals (any ages). Additional individuals will be$50.00 per person (all ages).

Regular registration after July 1, 2019

Single registration will be $150.00. Single registrants only, no additional individuals can be added to your regis-tration.

Family member registration will be $250.00 for up to four individuals (any ages). Additional individuals will be$50.00 per person (all ages).

Non-members registration will be $300.00 for up to four individuals (any ages). Additional individuals will be$50.00 per person (all ages).

Paper Registration form can be found at: https://fivepminus.org/wp-content/uploads/2018/02/Paper-Registration-

form.pdf

Scholarship Opportunities

The 5p– Society is pleased to announce that it will offer five (5) full scholarships for the 2019 Portland conference. Scholarships will assist families who cannot fully afford to attend a conference. The scholarship will consist of paying the member registration fee for up to four individuals ($200.00) (this includes your individuals with 5p– Syndrome as one of the individuals) in the same family, hotel fee three nights ($189.00++ per night), family event for up to four individuals, sibling event for up to two siblings, and up to four t-shirts. Please note, you may not split the scholarship among two different families, recipients must be from the same family. The scholarship will not pay for any inciden-tals (food, telephone, movies, etc.), and will not pay for transportation to the conference. For more information and to read the Guidelines, please click here: https://goo.gl/forms/EguDmlK76Q9Q29rl2

Volunteer Opportunties

The conference committee is actively looking for volunteers to assist with various areas of the conference, including Kid Care and the Sibling Outing. If you have family members or friends that live in Portland that can lend a hand for a few hours on Friday morning or Saturday morning/afternoon. We ask that all volunteers fill out the Google Form at: https://goo.gl/forms/nMaNu0MXdcSyTi1w1

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Hospitality Suite: Several years ago the Hospitality Suite was renamed AmySue’s Place. Dr. AmySue Reilly

is one of our long time supports and annual speakers with a lot of experience working with children and adults with 5p– Syndrome. She first joined us in 2003 in Memphis as a volunteer speaker and has attended every conference since on a volunteer basis.

This year, we will also be honoring a young adult with 5p– Syndrome who passed away a few years ago. Emily Turner’s family has graciously volunteered to host the AmySue’s Place all three nights of the conference as a way to honor her. We are deeply grateful to the Turner family for their continued support of the 5p– Society. The Turner family also sponsors one of the five scholarships that are given out annually.

AmySue’s Place will be open from 7:00 PM to 11:00 PM Thursday and Friday, 9:00 PM to 11:00PM on Saturday as a way to wind down, continue conversations, and grab a snack and drink. All are welcome.

Raffles and Gear: We have been so blessed by families and friends of families for handmade items such as

quilts and decorative items, as well as donate various clothing, jewelry, books, totes and other items to raffle off at the conference. There will also be a Kids Quilt designed by our kiddos at the 2018 conference, pieced together and quilted by Jorica Veres and presented to be raffled off this year. Jorica will be walking around the conference to acquire more handmade designs by our kiddos for next year’s quilt.

We will also have plenty of 5p– gear for you to purchase (hats, wristbands, key chains, etc)

Photographer, Banquet & Family Dance: Saturday night is the highlight of the event with the Ban-

quet and Family Dance. First will be a photo opportunity for a family portrait, followed by a sit down plated din-ner. Raffle winners will be announced and acknowledgements made.

As soon as all the formalities are out of the way, the dance floor will open up!! Watching the kiddos dancing and having so much fun is not to be missed. A time for the parents to let loose!!

General Meeting of the Membership: On Saturday afternoon, before the Professional Panels, we will

have the General Meeting of the members. Don’t miss it as your vote counts. We will be installing your newest Board of Directors. Interested in become a Board of Director, please contact Jolene Towers at gnjtowers@aol.com for more information.

Hall of Fame and Founder Awards: On Saturday afternoon, just after the General Meeting and the

Professional Panels, Kent Nicholls will announce and present his Founder Awards to members who have attended 5, 10, 15, 20 or more conferences (in 5 year increments). Laura Castillo, Executive Director, will then present the win-ners of the Hall of Fame Awards. There are four Hall of Fame categories: Parent(s) of the Year, Grandparent(s) of the Year, Sibling(s) of the Year, and Superhero Volunteer of the Year award. To nominate an individual for one of these categories who has gone above and beyond for the 5p– Society, please fill out and submit the Hall of Fame Nominations Form located at: https://goo.gl/forms/rFnyQC3JUy4h9xo72

T-Shirts: Attendees may order a commemorative t-shirt with their conference registration. T-shirt sizes and pric-

es will be Youth XS to Adult XL $10.00 each and Adult XXL to 4XL will be $12.00 each. Shirt color will be Natural for attendees, white for volunteers. If you are not attending the conference and would like to order a t-shirt, please contact Laura at director@fivepminus.org for an order form.

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Proposed Schedule Thursday, July 18, 2019

5:00 PM Registra on Begins

5:00 PM to 7:00 PM Welcome Recep on

7:00 PM to 9:00 PM New Family Orienta on

7:00 PM to 9:00 PM Sibling Mixer

7:00 PM to 11:00 PM AmySue’s Place Opens

Friday, July 19, 2019

7:30 AM to 11:50 PM Child Care Opens and Closes

8:30 AM to 9:00 AM Welcome and Opening Session

9:00 AM to 10:30 AM Parent Sessions

9:00 AM to 11:45 AM Sibling Workshop

10:30 AM to 11:45 AM Dad’s Workshop

10:30 AM to 11:45 AM Mom’s Support Shop

12:00 PM to 12:30 PM Transporta on to Family Event

12:30 to 3:30 PM Family Fun Event: Na onal Historic Oregon Interpre ve Center

4:00 PM to 6:00 PM Grandparents Workshop

Dinner is on your own

7:00 PM to 11:00 PM AmySue’s Place Open

8:00 PM to 11:30 PM Board of Director’s Mee ng

Saturday, July 20, 2019

7:30 AM to 11:50 PM Child Care Opens and Closes

9:00 AM to 4:00 PM Sibling Ou ng‐Oaks Amusement Park (lunch provided)

9:00 AM to 10:20 AM Concurrent Breakout Sessions

10:30 AM to 11:50 AM Concurrent Breakout Sessions

12:00 PM to 2:00 PM Lunch is on your own

12:00 PM to 1:45 PM Volunteer Lunch (Child care and conference volunteers)

12:00 PM to 1:45 PM Professional Advisory Board Lunch by invita on

1:45 PM to 5:00 PM Child Care Opens and Closes

2:00 PM to 3:20 PM Concurrent Breakout Sessions

3:30 PM to 4:00 PM General Mee ng of the Members, Hall of Fame and Founder

Awards

4:00 PM to 5:00 PM Professional Panels

5:30 PM to 6:30 PM Family Pictures available

6:30 PM to 10:00 PM Banquet, Raffles, Acknowledgments and Family Dance

9:00 PM to 11:00 PM AmySue’s Place Opens

Sunday, July 21, 2019

9:00 AM to 12:00 PM

Special Presenta ons Closing Session Talk about Chicago 2020 Pictures

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Speaker Information Dennis Campbell, Ph.D. • Cri du Chat 101

Associate Professor of Special Education at the University of South Alabama. Dr. Campbell is the parent of a Young adult, Amy, with 5p- Syndrome. He chairs the Professional Advisory Board for the 5P Minus Society and has worked with many other parent support groups. He chairs the Human rights committee which reviews, and approves rights restrictions for several of the local agencies that serve individuals with cognitive and intellectual disabilities as well as mental illness. He has researched, published and presented extensively regarding Cri-du-Chat Syndrome, disability advocacy, and transition. Dennis was named Parent of the Year in 2014 with his beautiful wife Shari.

AmySue Reilly, Ph.D. • Effective Positive Behavior Strategies

Dr. AmySue Reilly is retired from Auburn University. She was an Associate Professor of Special Education, Rehabilitation and Counseling, Dr. Reilly is a member of the Professional Advisory Committee for the 5P Minus Society. She has presented at the past 13 conferences on Behavior Modification. She has also researched and published along with Dr. Campbell regarding Cri-du-Chat Syndrome, disability advocacy and transition. Dr. Reilly was named 2014 Super Hero of the Decade! Because of Dr. Reilly’s continued support of the 5p- Society, the Hospitality Suite has been renamed AmySue’s Place in her honor.

Kent Nicholls • New Family Orientation

Like you, Kent Nicholls is the parent of a child with 5p- and is always searching for information and resources to help his daugh-ter live a better life. As the founder of the 5p- Society, Kent has participated in every 5p- Society Annual Conference and has helped families connect, provide mutual support, and learn from each other. Kent currently serves on the 5p- Society Board of Directors and is chairman of the Strategic Planning Committee. Kent has previously served on the Board of Directors for the March of Dimes and The ARC, as well as technology advisor to the Children’s Center for the Visually Impaired and the Bloch Can-cer Survivors Park, all in Kansas City. Kent is an IT Solutions Consultant, having contributed to the success of some of the key in-novators in technology, including Apple, Dell, and Microsoft. He is also a strong advocate for climate change mitigation.

Mary Anne Elhert • Journey Through an Eight Step Special Needs Planning Program and ABLE Act

Our founder, Mary Anne Ehlert, CFP, had a successful career in the financial industry when she decided to act on her lifelong de-sire to specialize in serving the families of the disabled. The source of her inspiration was very dear to her heart. Mary Anne her-self had come from such a family. Her younger sister, Marcia, to whom she felt especially close, suffered severe mental handicaps due to cerebral palsy. Although their parents were naturally determined that Marcia should get the best possible care, they had also been understandably confused how best to plan and provide for her future.

Patrick Tomblin • IEP

Patrick Tomblin, Executive Director of Special Services, for Lake Oswego School District, has a long history of work in Special Ed-ucation. Tomblin, has been in his current position since 2007 and before that, was director of special programs for 6 years in the Greater Albany Public School District. In addition to his years as director of special education programs, Tomblin has taught spe-cial- needs children and has been an adjunct professor at Western Oregon University, teaching a master's- level course in special-education law.

Dréa Peterson, MD • The Genetics of 5p-

Drea Petersen, M.D., is a pediatrician and clinical geneticist. Dr. Petersen believes in comprehensive diagnostic evaluation and multidisciplinary, family-centered approaches to care for patients with suspected and diagnosed genetic conditions. She is com-mitted to expanding access for patients and families from prenatal through adulthood, with current emphasis on neurofibroma-tosis, cancer predisposition, cardiac/vascular disorders, craniofacial and skeletal anomalies and hearing-loss. She is involved in clinical trials and therapeutics including IV and/or intrathecal enzyme replacement therapy for storage disorders, Nusinersen/Spinraza for Spinal Muscular Atrophy (SMA), and bisphosphonates for osteogenesis imperfect (OI). Born in Seattle but raised oversees in Bahrain, Dr. Petersen is thrilled to be back in the Pacific Northwest, which she enjoys exploring in her free time with her husband and two kids.

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Leisha Vogl, MS, CCCLP • Speech Therapy

Leisha has been working in the field of speech-language pathology since 2006. She has extensive training in the areas of accent reduction and modification, bilingual communication disorders, articulation/phonology disorders, early language development, and orofacial myology disorders (i.e. tongue thrust, and has received extensive training by the International Association of Orofa-cial Myology). She is PROMPT trained. Her experience extends from Early Intervention/Early Childhood Special Education and School-Age clients to the Hospital in Acute Care. She is conversationally fluent in English, Spanish, and American Sign Language. She received her Master’s degree in Speech-Language Pathology from Nova Southeastern University in Fort Lauderdale, Florida. Leisha holds her Certificate of Clinical Competency (CCC) from the American Speech-Language and Hearing Association and her license through the Oregon Board of Examiners. She in an active member of the Oregon Speech-Language and Hearing Associa-tion. Leisha’s hobbies include teaching English to adult English Language Learners and many outdoor activities like camping and hiking.

Barbara Kay Roberts • Advocacy & Empowering Parents, Making a Difference

A descendant of Oregon Trail pioneers and a fourth generation Oregonian, Barbara Kay Roberts (née Hughey; born December 21, 1936) is an American politician from the state of Oregon. A native of the state, she served as the 34th Governor of Oregon from 1991 to 1995. She was the first woman to serve as Oregon governor, and the only woman elected to that office until 2016. A Democrat, Roberts was also the first woman to serve as majority leader in the Oregon House of Representatives. She also won two terms as Oregon Secretary of State, and served in local and county government in Portland. Roberts was married to Oregon state Sen. Frank L. Roberts from 1974 until his death in 1993. From February 2011 until January 2013, she served on the council of Metro, the regional government in the Portland metropolitan area. Divorced with two children, she was working full-time when she began her political journey as a citizen lobbyist working to persuade the legislature to provide education for children with disabilities. Her success reinforced her belief that one person can make a difference. With her older son, Mike, diagnosed in 1962 as "severely emotionally disturbed" (later identified as autism), she became an advocate for special-needs children. In 1971, she successfully lobbied the Oregon State Legislature to require public schools to guarantee educational rights to these children.

Sherry Manion • Love and Logic Institute - Guilt Free Parenting

My interest in the Love and Logic consequence style of Parenting, started when my children were 11 and 16. I owned an in home childcare and it would also help with my business. My college education in Early Childhood Education and Child Development focused on children 6 weeks to 6 years. I enjoyed the Love and Logic sessions so much and valued how much I used the tools in my childcare business. When my youngest was in college I started to teach preschool, and I used the Love and Logic knowledge when teaching therm. I started teaching parenting classes in 2000. My first one was with young parents raising their babies. This lead to having the opportunity to go to Colorado and attend the seminars from Jim and Charles Fay. This was a life changing experience. I felt I had first hand knowledge of the curriculum. Sharing the parenting skills that so easily adapt to each family is also a great attraction to me. There is no one way to parent. Doing my 40 years of childcare and now taking care of my grand-children has kept me focused on how important these life skills are.

Natalia Rodriguez • Facilitator—Mom’s Support Shop — Energy & Self Care

Natalia Rodriguez is not only a mom to a 5p– syndrome daughter (Neesee 11-years-old), but also a Certified High Performance Coach. Natalia, her husband Joel, and their two children live in Tucson, Arizona. She owns multiple successful businesses & wears the titles of: Wife. Mom. Boss. Coach. When she's not teaching she enjoys traveling, dancing, & making music. Also you can al-most always catch her with a book in her hand

Nick Wallace • Facilitator—Father’s Seminar

Nick Wallace and his wife Angie, and their three children live in Bellefontaine, Ohio. Nick is the current President of the 5p– Soci-ety. He has served on the Board of Directors for over 10 years. Nick has a 15-year-old daughter, Allie with 5p– Syndrome.

Gloria Griffin • James & Frances Bodle • Co-Facilitators—Grandparent’s Workshop

Gloria Griffin is grandmother to Landon (15-years-old) and is from Louisville, Kentucky. Gloria is currently serving as the Secre-tary of the 5p– Society. She has led or co-led the Grandparent’s Workshop for over 10 years. Gloria was named Grandparent of the Year in 2012.

Jim and Fran Bodle are grandparents to Katie (31-years-old) and are from Costa Mesa, California. The Bodle’s transport all the 5p– Society supplies to the conferences and have made several cross-country trips. The Bodle’s were named Grandparents of the Year in 2011.

Please subm

it this form if you w

ould like to pay with a check or m

oney order. Use the

following links to register online w

ith your credit or debit card:

Mem

ber Registration link:

Non-M

ember R

egistration link:

Single Mem

ber Registration link:

Single Non-M

ember R

egistration link:

Dates to rem

ember:

Early bird discounted registration due by July 1st.

Register before July 1st to get a $50.00 discount on registration fees. There are tw

o options for R

egistration, a Single Mem

ber ($100) or Single Non-M

ember ($150) R

eg-istration and a M

ember ($200) or N

on-Mem

ber ($250) Registration for up to four peo-

ple. Each additional person will be $50.00 regardless of age. You w

ill have the op-tion of choosing an adult or child’s m

eal for your children. Please fill out completely

for each person who is attending. If you require additional inform

ation, please send an em

ail to director@fivepm

inus.org.

After July 1st, the price will increase $50.00. Single M

ember ($150), Single N

on-M

ember ($200), M

ember registration ($250) and N

on-Mem

ber registration ($300). Each additional person w

ill be $50.00.

**Please note that a Single registration cannot add additional people to their registra-tion.

T-shirts

T-shirts may be ordered below

. If you are not attending the conference, please check the box below

that says T-shirt order only, fill out the information below

and go to page 3 to provide your t-shirt order. T-shirts are natural w

ith the conference logo. Volunteer shirts are w

hite with the conference logo on it. To guarantee your t-shirt

order is received, please submit no later than June 20, 2017. There w

ill be a limited

supply of extra shirts at the conference for purchase. How

ever, to guarantee your size, please order below

. T-shirts will be delivered at the conference, or w

ill be shipped out after the conference. If you have any questions about this conference registration, please call 1-888-970-0777.

 

PIO

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F NE

W FR

ON

TIE

RS

2019 C

ON

FER

EN

CE

RE

GIS

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ION 

Information to help us plan a little better

Will you be driving or flying? _____________________________________

Are you staying at the Conference hotel or off site? ___________________

Did you order a crib from

the hotel? _______________________________ D

id you order a refrigerator from the hotel? _________________________

Do you need a high chair? ______________________________________

Let’s add it all up!

 

 

Please make a check or m

oney order payable to the 5p- Society and mail to:

5p- Society PO

Box 268 Lakew

ood, CA 90714-0268

Registration fee 

Mem

bers Early Bird (Before 7/1/2019)  After 7/1/2019 

$200.00  $250.00 

 

Registration fee 

Non-M

embers 

Early Bird (before 7/1/2019)  After 7/1/2019 

$250.00   $300.00 

 

Single Mem

ber-R

egistration  Early Bird (before 7/1/2019)  After 7/1/2019 

$100.00   $150.00 

 

Single Non‐

Mem

ber  Registra

on 

Early Bird (before 7/1/2019) 

Aer 7/1/2019 

$150.00 

 $200.00 

 

Additional Person  

# $50.00 each 

 

T-Shirts – sizes YXS to AXL  

# $10.00 

 

T-Shirts – sizes A2XL to A4XL  

# $12.00 

 

Family Fun Event 

Individual with 5p

- is free 

# $3.00 

 

Mem

bership D

ues  1 year 

3 years 

$25.00 

$75.00 

 

Donation in Lieu

of attending    

   

Total   

Tell us whose com

ing

Mem

ber  or Non‐M

ember Registra

on  

Single  Registra

on 

Person 1 Person 2 

Person 3 Person 4 

Nam

e 

Relationship

to individual w

ith 5p- D

ietary N

eeds T-Shirt Size(optional)

Age of Child 

Child C

are? Y or N

 

Sibling Out-

ing Y or N

 

Meal C

hoice Adult or C

hild 

(If you have more people com

ing, please add them to a separate paper).

T-Shirt sizes YXS to AXL are $10.00 each. T-Shirt sizes A2XL to A4XL are $12.00 each

Family Fun Event w

ill be held on the Oregon Interpretive C

enter Friday, July 19 from 12:30 PM

to 3:30 PM

. The cost to attend will be $3.00 per person (child w

ith 5p- is free). Transportation and lunch w

ill be provided.

# of Tickets: ______________

Photo Release:

I/we acknow

ledge that I/we and m

y imm

ediate family m

ay be photographed, or recorded. I here-by release to the 5p- Society all proprietary rights and copyrights in all such photographs, digital im

ages, voices, recordings, actions, films, and likenesses (including negatives, positives and

prints) which shall be and rem

ain the property of the 5p- Society. I understand that this material

may be used in various publications, public affairs releases, recruitm

ent material, and broadcasts

or for other related endeavors. This material m

ay also appear on the 5p- Society’s website and

other public social media sites.

I expressly release the 5p- Society, its directors, officers, employees, agents and volunteers from

any and all claim

s, including copyright and privacy, arising out of any reproduction, broadcast distribution publication or prom

otion of this event.

______________________________ ____________________________

SignatureSignature

$50.00 each Additi onal Person  

Person 5 Person 6 

Person 7 Person 8 

Nam

e 

Relationship to

Individual with

5p- 

Dietary N

eeds 

T-Shirt Size(optional)

Age of Child 

Child C

are Y or N

 Sibling O

uting Y or N

 

Meal C

hoice Adult or C

hild 

Nam

e: Phone N

o. 

Address: Em

ail: 

City: 

State/Province: 

Zip/Postal Code: 

Country: 

Basic Informa

on 

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Westward Expansion Rewards Program

Raise funds for the 2019 Conference and get rewarded!

Chimney Rock Rewards: For a $1,500.00 donation, families can have the basic registration fee paid for up to four individuals ($200).

Independence Rock Rewards: For a $3,000.00 donation, families can have the basic registration fee paid for up to four individuals ($200), and one room at the hotel ($189.00++ per night) for one night*.

Soda Springs Rewards: For a $5,000.00 donation, families can have the basic registration fee paid for up to four individuals ($200), and one room at the hotel ($189.00++ per night) for three nights*.

*Reward recipients to make their own hotel reservation, internal change will be made for payment of room. Conference registration form required. Please submit all monies by June 30th to participate

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PO Box 268 Lakewood, CA 90714

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