! ! Advancing Occupational Therapy 2014 ________________________________________ Competent Clinical Practice Research and Development Political Advocacy ! North Carolina Occupational Therapy Association! Annual Conference October 18-19, 2014! Novant Health Conference Center Winston-Salem North Carolina Occupational Therapy Association PO Box 20432 Raleigh NC 27619 www.ncota.org office@ncota.org 919-785-9700 TIRED OF HEARING “WHAT? I CAN’T UNDERSTAND YOU.”? SOLUTION: Speech-to-Speech Relay Services offer people with speech disabilities confidence to talk on the phone with ease! DIAL ... 711 and ask for STS or 877-735-8261 To learn more about Relay NC Speech-to-Speech, please visit: www.relaync.com/sts For more information or to request a free presentation, contact: Bola Desalu, Relay NC Manager 919-324-3792 Voice/Videophone bola.desalu@sprint.com 24 Hour STS Customer Support 877-787-1989 Sprint.TRSCustServ@sprint.com North Carolina Division of Services for the Deaf and Hard of Hearing www.relaync.com I can make my “ownNow phone calls without having to depend on someone else. ” Welcome to the 2014 NCOTA Annual Fall Conference. This year we have some exciting changes and additions. The Keynote presentation on Saturday and the Capstone Address on Sunday should be inspiring to OT practitioners in all areas of practice. There will be 6 breakout sessions with workshops available in several tracks: Pediatrics, General, Physical Disabilities, Mental Health, and Assistive Technology. Our Special Interest Section (SIS) Sessions have expanded to 75 minutes so you have more opportunity to meet and network with other people in your practice area, and discuss a key issue facilitated by the SIS Chairperson. Altogether, there is the opportunity for 13.25 hours of continuing education credit, which nearly satisfies the license renewal requirement. Join us also on Saturday evening for socializing, refreshments, and the Silent Auction, which will help raise money for the NCOTA Scholarship Fund. In addition there will be a raffle, with prizes awarded on Sunday during the NCOTA Annual Business Meeting and Awards Luncheon. Once again, parking and lunch are included in your registration fee. Brenda Kennell, OTR/L Nancy Murphy, OTR/L NCOTA Continuing Education Co-Chairpersons Professional Development/Educational Program • Educational sessions include clinical knowledge and skills, career development, and other topics related to 7 Special Interest Sections. • Earn 13.25 contact hours of CE credit from a single conference registration, • Continuing competency: All professional development programs offered by NCOTA are pre-approved for continuing competency credit by the North Carolina Board of Occupational Therapy (NCBOT). An NCOTA certificate of attendance detailing sessions/hours accrued will be issued to registered attendees. Attendance will be recorded at each session. NCOTA Members receive a substantially discounted rate on conference attendance. If you want to join to receive the member registration rate, go to the website: www.ncota.org and join online OR download a membership form and submit with your registration OR complete the membership application on the back of the registration page. If you pay by check, submit 2 separate checks̶one for registration and one for membership. Registration Policies: (check dates on registration page for early discount, regular rate, and important deadlines) • Online registration will be available on the NCOTA website! www.ncota.org • Registration status will be verified with the membership database. If you register as a member and your membership status is not current, you must join or pay the difference (non-member rate) in order to attend. • All registrations received by October 12th will receive a confirmation email prior to conference. If you do not receive a confirmation email by then and want one, contact the NCOTA office. • Full refund less $25 administrative fee will be given if notification of cancellation is received by October 12, 2014. After that date, no refunds are permitted, but you may substitute another person to use the registration. • No faxed or mailed registrations will be accepted after October 12th. Online registration will not be available after that date. • Onsite registration is available. There is a $20.00 fee in addition to the regular registration rate. Reasonable Accommodations Attach a letter with a detailed description of your needs and submit with your registration. ! Lodging: Information on local hotels will be posted on the website. If you want to do your own search, the address is 3333 Silas Creek Parkway, Winston-Salem, NC 27103 Book your room early since this is homecoming weekend for Winston-Salem State. ! ! Contact NCOTA at admin@ncota.org 919-785-9700 Fax 919-771-0115 Saturday October 18, 2014 7:30 Registration Desk Open 8:15-9:30 ! 9:30 ! Welcome, Conference Overview Important Updates from NCBOT, AOTA and WFOT Break Keynote Address 9:45-11:45 ! ! Take Care of Yourself First: Three Lessons in Self Care from a Long-Distance Motorcyclist Tamela Rich, Award Winning Author and Speaker Tamela has traveled across North America on a motorcycle, searching for life lessons from people facing health crises: patients, caregivers, friends and family members. She collected their wisdom in her awardwinning book, Live Full Throttle: Life Lessons From Friends Who Faced Cancer. Tamela will share three of these lessons that occupational therapists can directly apply to their lives, helping them embrace the importance of self-care for the sake of their loved ones, the clients they serve, and ultimately themselves. ! 11:45-1:45 !! Lunch (included with registration) Visit with exhibitors, review posters, view silent auction items. 1:45-3:30 1A Successful Psychosocial Group Interventions: Strategies Styles and Content Deborah Dunn, BS, OT/L, Julie Toporek, MS, OTR/L, Lindsey Ellington, MS, OTR/L, Jacqueline Allotey, MS, OTR/L, Caity Bunch, MS, OTR/L, Stephanie Ready, OTS This session will focus on types of group interventions utilized with clients who have psychosocial needs, utilization of the therapeutic self to make a critical difference in the efficacy of your interventions and how to manage disruptive behavior in a group setting. Examples of groups will be discussed and how to modify to capitalize the client's strengths and interests in order to change the groups dynamic balance. Types of groups cover the range from health & wellness, recovery, social, coping and community life skills. MH ! 1B Keeping the PACE: The PACE Model Facilitates Productive Aging in Place Cathrine Balentine, MS, OTR/L, James Proctor, OTS As the older adult population in the U.S. grows rapidly, so do their healthcare needs Furthermore, as the country faces problems associated with demands on the healthcare system, it becomes crucial to embrace innovative solutions to address these challenges. This session is designed to enhance your understanding of one of these innovative solutions, the Program for All-Inclusive Care for the Elderly (PACE); this model of care will provide the context to explore concepts of aging in place and productive aging. Attendants will learn about the ever evolving role of OT within one North Carolina Program, as the PACE team works to improve its ability to fulfill its mission to support frail older adults to remain safely in the community with the highest quality of life possible. GERI/PD !1C Pediatric Power Mobility, Assessment and Access Tony Leo, MOT, OTR/L, ATP This presentation is designed for OTs/OTAs working with pediatric populations. It is centered on how to assess / evaluate clients for power mobility devices. It covers the importance of early mobility, examines current pediatric power wheechairs, access methods and examples. PED/AT !1D Enacting the Centennial Vision: Bridging the Gap between Students and Practitioners as Emerging Leaders David Benthall, MS, OTR/L, QDCS, Christine Gunnigle, MS, OTR/L, Stacy Wilson, MS, OTR/L, Amy Mahle, MHA, COTA/L As the realization of the Centennial Vision approaches, there has never been a better time for new practitioners to engage in leadership opportunities within the OT profession. This short course is designed for OT/OTA students and new OT practitioners to identify supports and barriers to their personal leadership capacity, as well as strategies to embrace emerging leadership opportunities on a personal, local, and global level. Participants will be inspired by stories of active leadership from a panel of occupational therapy practitioners who have embraced early leadership opportunities in the profession. This interaction session will also illustrate how to become involved in leadership activities as an early OT practitioner, as well as ignite your passion to serve, grow, and develop your leadership story. GENERAL !! 1E Rehab Stroke Standards of Care- Process and Updates in a Comprehensive Stroke Center Sanchala Sen, MS, OTR/L, BCPR This workshop will describe in detail the process and subsequent updates in formulating and implementing the rehab stroke standards of care in a comprehensive stroke center in NC. It will highlight the changes made on an ongoing basis based on the deficits identified and areas of education needed by therapists working on the acute stroke unit, especially in areas of cognition and vision. It will benefit attendees who wish to learn more about specific stroke care both in areas of assessment and intervention. PD/GENERAL ! 1F Item Writing Workshop: Tips and Strategies for Writing Multiple Choice Questions (Ed) Denise Donica, DHSc, OTR/L, BCP Testing the knowledge of others is a skill. One approach often used in testing others is multiple choice question exams and quizzes. This workshop will provide tips and strategies for writing good multiple choice questions combined with opportunities to apply these skills within the session. All material was developed by the National Board for Certification in Occupational Therapy and NBCOT retains the ownership of all workshop materials. !3:30 Break 3:45-5:30 Psychological Consequences of Stroke for Survivors and Caregivers: Assessment and Intervention Mary Hildebrand, OTD, OTR/L There are about 6.8 million Americans who have had a stroke and 795,000 persons who experience a stroke each year. Up to 50% of stroke survivors may experience stroke-related psychological or emotional disorders such as depression or anxiety. However, many OTs focus solely on the physical impairments of stroke even though psychological conditions have a significant negative effect on the stroke survivor’s overall health outcomes. Psychological assessments and interventions for the stroke survivor will be discussed. Additionally, stroke rehabilitation guidelines state that the caregiver is the most important environmental factor for the stroke survivor. Evidence-based caregiver assessment and a caregiver treatment framework, “Timing It Right”, will be discussed. MH 2A! !3:45-6:30 (Two successive workshops in one room.) 2B-1 It’s A Man’s World Too! Gender Bias in Occupational Performance Activities (1.75 hrs) ! Susan Blair, OTR/L, BCPR The lack of gender specific interventions for male patients is evident in the scarcity in availability of appropriate occupational performance activities in inpatient rehabilitation centers. This may lead to a decline in male role delineation; psychosocial well being and gender de-affirmation as population ages and skews to a higher female ratio. This presentation discusses gender-based research; provides examples of gender-bias free evaluation tools and demonstrates gender appropriate interventions, which meet the functional occupational performance needs of male patients in today’s rehab environment. GERI/PD !2B-2 Turner Syndrome and Beyond: Living Life to the Fullest (1 hr) Megan Edwards, PhD, OTR/L The current study explored the lived experience of women who have Turner Syndrome. Twelve adults with Turner Syndrome were interviewed to research the impact Turner Syndrome has had on their daily life and the lives of their family members. In general, participants felt that they grew up like “normal” children. They emphasized that those with Turner Syndrome can lead happy, healthy lives, and offered advice for family members impacted by Turner Syndrome. This included not letting the label of “Turner Syndrome” hinder them from seeking their dreams, and utilizing resources from the Turner Syndrome Society. Participants also had recommendations for healthcare professionals, such as becoming educated on Turner Syndrome and providing families with resources. Findings will be related to other diagnoses and to occupational therapy. GERI/PD (Two successive workshops in one room.) 2C-1 Assistive Technology Devices and Strategies for Persons with Low Vision Jennifer Radloff, OTD, OTR/L, CDRS Leonard Trujillo, PhD, OTR/L, FAOTA The purpose of the session is to enhance the OT practitioners understanding of available assistive technology devices and compensatory strategies that can be used with persons that have low or impaired vision. Participants will have the opportunity to experience various magnification devices and visual enhancement viewers. In addition, Windows and Mac built-in accessibility features and options will be demonstrated. The session will include discussions of how the technology and strategies can improve occupational performance for persons with low or impaired vision. AT 3:45-6:30 (cont’d) 2C-2 Phone Zone: For People with Speech Disabilities Joan Black In today’s world all people, with disabilities or without, must be able to communicate with others over the telephone (landline, cell, or IPAD) at home, office or out and about. The Relay North Carolina Speech to Speech Service provides telephone accessibility, at no charge, for people with speech difficulties; occupational therapists will be able to encourage their patients to get back on the phone for independence, security and better quality of life as well as how to access their own services of information and support. AT ! 2D! Mobilizing the Morbidly Obese Patient: An Interdisciplinary Approach Anne Kelly, OTR/L, BCPR Andrew George, PT, DPT, MPH Our presentation will help prepare clinicians to care for the medically complex bariatric patient. This program was developed through interdisciplinary work between Duke University Hospital OT/PT Division, Duke University DPT Program, Duke School of Nursing, and Duke Ergonomics Department. Our program will examine the medical complexities that impact therapeutic intervention and must be considered when preparing to mobilize the patient population. We will also review assessment and interventions to improve functional mobility and completion of activities of daily living. GENERAL !(Two successive workshops in one room) 2E-1 The Role of Occupational Therapy with Clients with ALS / MND (1.4 hrs) Francesca Monachino, OTR/L Melissa Uhl, OTD, OTR/L Amyotrophic lateral sclerosis (ALS) is a progressive disease which presents with Lower Motor Neuron signs with focal onset of weakness or initial Upper Motor Neuron symptoms of jerking or stiffness. Clients are followed on a regular basis by OT at the Duke ALS Clinic. ADLs are reviewed. Adaptive devices, splinting, DME options are discussed. Problem solving skills and family training are addressed. The OT screens for driving safety. Clients struggle with the progression of impairment and accepting our recommendations. We may determine that a comprehensive OT driving evaluation and “Behind the Wheel“ test are warranted. PD/GEN 2E-2 !Best Practices for Oncology Rehabilitation (1.4 hrs) Sarah Sangermann, MS, OTR/L Brittany Lorden, OTR/L Lisa Malec, OTR/L, CLT-LANA Oncology Rehabilitation is an evolving specialty within the rehabilitation world. Individuals with cancer diagnoses require both specialized and integrated care, focused on the whole person and support system. With the newly developed Commission on Accreditation of Rehabilitation Facility standards for cancer rehabilitation, there is a significant focus on the delivery of cancer care. This session will focus on assessment, goal setting, treatment, discharge planning and coordination of care for individuals with cancer as it relates to the preventative, restorative, supportive, and palliative phases of rehabilitation care. PD/GEN !! 2F Transitioning to Teaching: It’s More (and Less) than Power Point Lectures! Beth Fain, OTR/L Brenda Kennell, OTR/L Baby Boomers make up the majority of the population in the academic settings and will be retiring soon. For OT practitioners interested in moving into education, now is a prime time to explore and engage in teaching the future practitioners. The increasing demands for faculty and the increasing educational opportunities for OT Clinicians are exploding. In this workshop, we will explore the similarities and differences of clinical practice and teaching, discuss opportunities to teach and learn how accessible it is to teach. We will then use this information to develop a teaching professional development plan and teaching opportunities with an OT/OTA program including the use of technology. This workshop will be highly interactive. Ed !_____________________________________________________________________________________ ! 5:30-7:30 Evening Reception and Silent Auction At the end of a busy day, please join us for our Evening Reception and Student Scholarship Auction. Meet Board members and your SIS Chairs or just hang out with friends. Enjoy a variety of hors d’oeuvres and refreshments. Funds from the auction contribute to NCOTA sponsored scholarships. The auction will end at 7:00. ! Sunday Program October 19, 2014 ! 8:00 Registration Opens ! 8:30–9:45 SIS Networking Sessions Group Facilitator Topic A Administration Page Riggs Leading Through Change B Assistive Technology Amber Ward AT Options for Persons with Progressive Disorders C Pediatrics Alisha Baker Kristin Burgess Discussion and problem solving among school based and outpatient pediatric therapists to begin to create a framework for collaboration. D Home Health Mary Hildebrand AARP’s "Home Fit” Program: Helping Older Adults to Safely Agein-Place E Mental Health Allison Taylor Review of Evidenced-Based Practices in Psychosocial Practice and Community Based Opportunities F OT Educators Amy Mahle Megan Edwards Building an OT Fieldwork Consortium G Gerontology David Benthall OT & End-of-Life Care: Optimizing Quality of Life through Meaningful Occupation H Physical Disabilities Sanchala Sen Commonly Used Standardized Assessments in Acute and Inpatient Rehab and Their Validity I Private Practice Beth Hathaway How to Use the Internet to Build Your Practice !Break 9:45-10:00 !10:00-11:45 3A Evaluations and Collaboration: Utilizing Our Role Effectively in Mental Health Valerie Fox, OTR/L, CPRP Caity Bunch, OTR/L This presentation will explore the role of OTs on interdisciplinary mental health teams, including how our evaluations and assessment findings can inform interdisciplinary treatment planning and enhance collaboration between disciplines. We will review frequently-used inpatient mental health evaluations, advocacy approaches, and common occupational issues found on inpatient mental health units. We will focus on occupational deprivation as one specific area that OTs are primed to address on inpatient mental health units and how we can best advocate and share the importance of our evaluation. MH !3B Using Therapeutic Gardening to Facilitate Optimal Patient Outcomes Twylla Kirchen, PhD, OTR/L This presentation will describe how one Veteran’s Home in NC transformed a forgotten outdoor area into an amazing garden environment that enhanced quality of life for patients, families and staff. An interdisciplinary therapy team embedded traditional rehabilitation goals into planning, planting, caring for, harvesting and cooking vegetables from numerous garden beds. The OT patients did not refuse therapy, reported feeling happier and healthier and met outcomes when or before expected. The presentation will provide a photo documented process of initiating a therapeutic garden, describe how to embed goals into gardening activities, discuss ways to adapt garden activities to allow for maximum patient participation and discuss precautions involved with using therapeutic gardening. GERI/PD 3C Set Your Sights High: Discover Visual Rehabilitation in Pediatrics! Michelle Yoder, OTR/L, CIMI Steven Haleo OD, FCOVD This workshop is designed to help OTs understand and identify visual challenges in the pediatric population and implement treatment strategies to improve performance at school, at home, in sports and leisure activities. We will explore the anatomy of the eye and visual system and learn specific visual skills needed for reading, writing and learning. Participants will learn brief screening methods to identify visual challenges and through interactive labs, learn treatment techniques to help the following areas: eye teaming and tracking, eye-hand coordination, visual motor integration and visual perception. PEDS/AT 3D Happiness: How to Apply this to Our Practice? Anne Fleischer, OT/L, CLT-LANA This session will explore various theories of happiness. Connections will be drawn between these theories and OT models. Case studies will be presented differentiating between “experiencing self” versus the “remembering self” of patients who have experienced happiness. Discussions will center around how theories of happiness can be applied to OT practice. GENERAL !! 3E Assessing Apraxia: Functional Measurement and Appropriate Intervention in Neuro Rehabilitation. Melissa Moser, MS, OTR/L Kirsten Brown, DPT Assessment and intervention of motor apraxia in the neurological rehabilitation population is complex in nature. The Occupational Therapist is uniquely qualified to evaluate and treat this often neglected aspect of neurological impairment. However, many therapists are uncomfortable in their clinical skills for addressing this deficit due in part to a lack of knowledge about appropriate measurement tools and process intervention. Historically, assessment is generally focused on elimination of other factors such as cognition, perception, tone and aphasia. In turn, interventional methods may be less effective and inadequate in improving the client’s occupational performance. This presentation will provide clarification of current research, discussion of formal evidence based assessment tools and demonstration of occupation based interventional methods easily incorporated into today’s clinical environment. PD/GEN ! 3F Unique Fieldwork Collaboration to Help Prepare Students for New Healthcare Systems Cathy Schweiker, MS, OTR/L Allison Bolin, MS, OTR/L Michele Redderson, MS, OTR/L As experienced clinicians we must provide opportunities for students to attain the skills needed to adapt to the many changes in the healthcare field. New graduates need to have the ability to articulate what OT is but also be able to describe what OT can accomplish in a variety of settings. Fieldwork educators and clinical instructors must adapt to a new reality of OT practice within changing healthcare environments. We will share how collaborative restructuring of the learning opportunities in two traditional fieldwork sites can prepare future practitioners to adapt to the new realities of OT practice along the continuum of care. We will provided examples and we will outline how CIs can collaborate & structure a Level II student’s learning to optimize the student’s learning opportunities in order to become a more well-rounded entry level practitioner. Ed 11:45-1:30 Annual Business Meeting and Awards Lunch Included with your registration. Help us recognize the exceptional work of your colleagues. ! ! 1:30-3:15 4A Initiation and Collaboration of OT and RT Programming in Psychiatry Shelley Sehorn, OTR/L Jayme Kirk, OTR/L Brittany Robertson, OTR/L This session will focus on the OT program at Wakebrook, a new psychiatric campus owned and operated by UNC Health Care. Program development of OT services on the inpatient psychiatric unit will be discussed. This facility also provides RT services on the inpatient unit and, given the overlap of scopes of practice with both therapies, a division of patient services was vital for the sustainability of both. This session, which include both OT and RT presenters, will review both the scopes of practice and explore this overlap, as well as how collaboration and utilization of both services are crucial in mental health practice. MH !4B A Framework for Generalists to Identify Safety Risk and the Pathways for Addressing Driving as a Valued IADL. Anne Dickerson, PhD, OTR/L, FAOTA Driving is a highly valued IADL for those who want to return to driving or learn to drive. Thus, it should be addressed by all OTs to determine safety risk, potential for learning or returning to driving, and when to refer to a specialist. This session will introduce a framework for generalists to use for determining risk and when to refer to a specialist, allowing all clients to have driving be part of their evaluation or intervention plan. GERI/PD ! Implementing Alert Program in K-2nd Grades: What We’ve Learned Carol A. Lust EdD, OTR/L & Monica Powell MSOT, OTR/L This 2 hour short course will present how the Alert Program was implemented to all students in a kindergarten setting for four years. A chronicle of the changes made to the program will be discussed based on what was learned from evidenced based literature, pre-test and post-test findings, input from the Alert Team members, plus informal feedback from the teachers and students. Different program formats used along with the sensorimotor equipment and materials the students enjoyed will be shared and different ways to track students’ performance. The presenters will also discuss the 6-8 week follow-up intervention program used for selected students at risk in the first and second grades and how it provided more student choice, control and sensory opportunities. PEDS 4C !4D Patients: Factors that Drive Their and Our Behaviors Caroline Berry, OTR/L This is a refresher course regarding illness/disability and recovery. Applies to many settings, but created especially for adult rehabilitation. We sometimes forget / tend to downplay the baggage that accumulates when recovering from illness / injury. This course is designed to refresh and recharge our understanding of patients as they recover and what strategies we can employ to help them. GENERAL !4E Implementation Science: A Guide for Moving Practitioners and Programs Forward Lauren Holahan, MSOT, PhD Candidate, OTR/L Laurie Ray, MPT, PhD Perry Flynn, MEd, CCC-SLP, AP This interactive workshop will equip participants with strategies for aligning therapists’ clinical reasoning and practice behaviors with institutional /agency / business goals, evidence, practice standards, and regulatory requirements. NC Dept. of Public Instruction Consultants in OT, PT and Speech will work from an implementation science framework, as well as their own experiences in effecting practice change from the state level, to explore with participants how to: lead therapists toward provision of mission-relevant services, keep pace with best practices and effect sustainable improvement in therapy programs. Participants will analyze their own practice situation, select a strategy and develop at least one plan for implementing change in a program or area of practice within the scope of their control. PD/GENERAL 4F Thrive (Not Just Survive) During Fieldwork Amy Mahle, MHA, COTA/L Christa Gaille-Weiss, MS, OTR/L, CAPS In this session the presenters will identify professional behaviors needed for successful fieldwork experiences, summarize communication strategies for conflict resolution, and compare experiences of successful OT and OTA graduates via a panel discussion. Ed !! 3:15-3:30 Break !3:30-5:30 Capstone Address: Advancing Occupational Therapy: The Evolution of the Occupational Therapy Practice Framework Debbie Amini, EdD, OTR/L, CHT, FAOTA The Occupational Therapy Practice Framework: Domain and Process, provides a generic outline of the profession’s unique domain of concern and outlines a process that explains how occupational therapy service delivery occurs within this domain. This document has been instrumental in guiding practitioners to clearly focus their practice on assisting others to attain, regain, or maintain their ability to participate in daily life activities. This presentation will highlight revisions from the recently completed 3rd edition of Framework and discuss application to various areas of practice and settings. ! ! ! ! ! ! NCOTA was founded in 1957. For 57 years this volunteer-run and supported association has been the primary statewide voice for the practice of occupational therapy in NC. The association organized and led the successful effort to obtain licensure in 1984. The list of licensed practitioners in NC has grown from a few hundred to over 4600. ! ! ! In recent years our efforts have expanded from enhancing competent practice and facilitating community to actively protecting the profession. Our lobbyist, Ashley Perkinson, has been working with the current Board during challenging times when employment and reimbursement seem under constant threat. ! ! ! ! As always, there is strength in numbers. If you are not a member, we hope you will join to add your support. A primary benefit of membership is the feeling and knowledge that you are making a positive contribution toward the advocacy of our profession and the future vision of the association. It is easy to do now online. Secure and easy. Just go to www.ncota.org and take a look around. Sign up or renew your existing membership today. Other News! Ethics! Beginning with this licensure year (ends May 31, 2015) you are required to have one hour of ethics training annually. As is our tradition, NCOTA will hold one or two regional continuing education events next spring and ethics will be included in both. Date and locations are being organized now.! ! Website! We are working on a brand new custom website. We hope it goes live soon. We think you will like it. There will be a few changes of course, including an improved member section. Instructions will be sent to active members on how to set up your log-in and profile.! NCOTA 2014 Annual Conference Registration ! (online registration and payment available: www.ncota.org) Name: _______________________________ OT __ OTA __ OTS __ OTAS __! ! ! Address ___________________________________________ City __________________ Zip ______________! Preferred Phone ____________________________ Email address ________________________________________! ! ! ! ! ! ! ! ! ! (must be legible)! Active Member Yes ____ No ____ (to join or renew and receive member discount, form is on back or online) 1. Keynote Address Saturday am ___ ! 2. Saturday Workshops ! 1A __ 1B __ ! 2A __ 2B (1 & 2) __ ! ! ! 1C __ 1D __ 1E __ 1F __ ! 2C (1 & 2) __ 2D __ 2E (1 & 2)__ 2F __! 3. I will ___ will not ___ attend the Reception Saturday evening! 4. Preferred SIS Meeting (Sunday am) (circle choice) A B C D E F G H I! 5. Sunday Workshops 3A __ 3B__ 3C __ 3D__ 3E __ 3F __ 4A __ 4B __ 4C __ 4D __ 4E __ 4F __! 6. Capstone Address Sunday pm ___! OT/OTA Member $185.00 Student Member $65.00 OT/OTA Non-member $235.00 Student Non-member $100.00 One day - Early (received by 9/15) Check day __ Saturday __ Sunday $130.00 $45.00 $170.00 $75.00 Full conference Sat-Sun - Regular (received by 10/12) $195.00 $70.00 $250.00 $110.00 One day - Regular (received by 10/12) Check day: __ Saturday __Sunday $140.00 $55.00 $180.00 $80.00 Full conference Sat-Sun - Early (received by 9/15) No pre-registrations accepted after October 12 Onsite available. Add $20 Speaker Discount is 25% (Fee x .75) Payment: (to join or renew and receive member discount, form is included on back of this page or online)! ___ I am paying by check, payable to NCOTA! ___ I am paying by credit card. Card number: ___________ ___________ ___________ ___________ Card expires: Month:_____ Year: _____ Security code: (3 digits on back of card after card number:) ___ Name as it appears on card: ______________________________________________ I authorize NCOTA to charge my credit card: $ __________ (email receipt will be sent to address provided at top of page)! MAIL your registration to: NCOTA, PO Box 20432, Raleigh, NC 27619 OR FAX your registration to: 919-771-0115 or register ONLINE (by credit card) at: www.ncota.org NCOTA voice mail 919-785-9700! 2014 Membership Application - Join Online at www.ncota.org ! ! ! ! ! ! ! ! ! PO Box 20432 Raleigh, NC 27619 919-785-9700 office@ncota.org Name ____________________________________ __ OT __OTA __ OTS __ OTAS! Address _________________________________City _______________ State ____ Zip _________! Preferred Phone ____________________ Email (legibly please!)_________________________________________! Employer / School _____________________________Address _______________________________________! City________________________ State ____ Zip _____________! Work Setting: __Academic __Early Intervention __Home Health __Schools __Hospital __Private Practice __Outpatient Rehab __Mental Health Setting __Skilled Nursing / LTC __Other _____________! Special Interest __ Administration / Management __ Gerontology __ Pediatrics __ Mental Health __ Home Health ! __ Physical Disabilities __Technology __ Developmental Disabilities __ Other _________________! Membership Fee: OT $75 OTA $65 New Therapist (first year) $45 Mail payment: __ By check. Make payable to NCOTA! __ By credit card Acct #_____ ! _______ ______ OTS / OTAS $45! ______ Exp. Date _____ Security Code ____! Name on card _______________________________ Signature ___________________________! Information is secured until processed and then shredded. To protect privacy we do not keep personal account information. An automated receipt will be sent to your registered email.! NCOTA! PO Box 20432! Raleigh, NC 27619
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