Registrations will not be processed without payment. Make checks payable to APDT.
Credit card payment can only be accepted by phone for security purposes. Please call 800-PET-DOGS.
APDT is pleased to offer a payment plan option. Registration fees can be split into monthly payments
and all payments must be received in full prior to August 1, 2019. Please contact the APDT office at
800-PET-DOGS or apdt@apdt.com for more information.
Please mail completed registration (with check payment only) to:
APDT, 2365 Harrodsburg Road, Suite A325, Lexington, KY 40504 | Fax: 859-201-1061
2019 APDT Annual Educational Conference
and Trade Show Registration Form
Please type or print clearly – this information will be used for your name badge.
To type and save, use the free Adobe Reader application. (For the digital signatures below and on the following
page, you will be prompted in Adobe Reader or Acrobat to choose a signature option. If you do not already have
a digital signature ID, when prompted select the third option, “Create a new Digital ID” and follow the steps.)
_______________________________________________ _____________________ ____________________________________
NAME APDT MEMBER # DESIGNATIONS
_____________________________________ _______________________ ______ ____________ ______________________
ADDRESS CITY STATE/PR ZIP COUNTRY
___________________________ _________________ _________________ __________________ _____________________
EMAIL BUSINESS PHONE CELL PHONE EMERGENCY CONTACT NAME EMERGENCY CONTACT PHONE
First APDT Conference? Y N Traveling with a service dog? Y N Vegetarian/Vegan? Y N
What CEUs will you need? None IAABC CPDT-KA CPDT-KSA CBCC-KA CCPDT ID # (required for CCPDT CEUs) _____________________
List any special needs (due by 09/26/19) __________________________________________________________________________________________________
CONFERENCE FEES: OCTOBER 30–NOVEMBER 2
Early Registration Ends August 1
Premium Professional
Member
Professional
Member
Supporting
Member
Non-Member
Early Regular Early Regular Early Regular Early Regular
1 Day $280 $340 $310 $370 $325 $385 $345 $405
2 Days $360 $420 $390 $450 $405 $465 $445 $505
3 Days $440 $500 $470 $530 $485 $545 $545 $605
All 4 Days $520 $580 $550 $610 $565 $625 $645 $705
I will be attending
Wednesday, Oct.30 Thursday, Oct. 31 Friday, Nov. 1 Saturday, Nov. 2
CONFERENCE FEES SUBTOTAL
$
T-SHIRTS AND HOODIES
T-shirts and hoodies must be pre-ordered and picked up at the conference.
T-shirts and hoodies cannot be shipped and will not be sold at the conference.
Item Quantity Desired of Each Size Price Each Total Qty Total
T-shirt S M L XL XXL XXXL $25 $
Hoodie S M L XL XXL XXXL $40 $
T-SHIRT AND HOODIE SUBTOTAL
$
TOTALS
Conference Fees $
Workshop Fees $
Power Hour Fees $
T-Shirts and/or Hoodie Fees $
Muddy Paw Pin ($20) $
Ziwi Welcome Reception Guest Pass ($25) purchase only for guests $
Foundation Reception Guest Pass ($25) purchase only for guests $
Friday Yappy Hour Guest Pass ($25) purchase only for guests $
TOTAL DUE
$
PRE-CONFERENCE WORKSHOPS
at Oregon Convention Center
Sponsored by PetSafe
®
Limited Space Available
Fear Free
SM
Workshop
with Debbie Martin, RVT, CPDT-KA, KPA
CTP, VTA, LVT, VTS (Behavior),
and Mikkel Becker, CBCC-KA,
CPDT-KA, KPA CTP, CDBC, CTC
(NOT a Hands-on Workshop)
Tues., October 29, 9am–4pm
Participant
$100 $
Ethologist for the Day
with Sue Sternberg and Tim Lewis, Ph.D.
(NOT a Hands-on Workshop)
Tues., October 29, 9am–4pm
Participant
$100 $
Tellington TTouch
®
Method
with Clare Swanger,
Senior Practitioner,
Tellington TTouch
®
Method
Tues., October 29, 9am–4pm
Participant
$100 $
POWER HOUR
Oregon Convention Center
Limited Space Available
Includes $10 Concessions Voucher
Sue Sternberg and Tim Lewis, Ph.D.
Wed., October 30, 12–1pm
Participant
$25
$
Michael Shikashio, CDBC
Thurs., October 31, 12–1pm
Participant
$25
$
Clive Wynne, Ph.D.
Fri., November 1, 12–1pm
Participant
$25
$
POWER HOUR SUBTOTAL
$
By attending the APDT Conference on the 29th day of October, 2019 (the “Event”) sponsored by the Association of Professional Dog Trainers (“APDT”), I understand and agree that I am assuming all
risks regarding the Event including, but not limited to, falls, contact with animals and participants, and any damage caused by animals, participants or guests.
Knowing these facts, I, on behalf of myself, and my heirs, executors and administrators (“Releasing Parties”), release and covenant not to sue and forever discharge APDT and all APDT officers,
directors, volunteers and parties associated with APDT and the Event (the “APDT Parties”) from any and all claims, foreseen or unforeseen for damages, or liabilities, including attorney’s fees and costs,
of any kind, by the Releasing Parties or any third parties, including all participants, organizers, offi cials, members, organizations, and any other person, animals, or organization participat ing in the Event
(“Covered Claims”). Further, I agree to indemnify APDT and the APDT Parties for any and all Covered Claims, for all damages, judgments, and other claims including attorney’s fees and costs.
I further grant full permission to APDT and its agents to au thorize by them any use of photographs, video, or any other recording of the Event for any purpose.
SIGNATURE _______________________________________________
click to sign
signature
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