AUTIS

Technology Conference and Grant Awards Ceremony
Followed By Our Membership Appreciation Picnic
Tuesday, April 21, 2015
12:30 to 4:00 pm
Wyndham Hotel
2 Riverfront Drive
North Little Rock, AR 72214
Contact: Chris Glewen at Chris.Glewen@arkansas.gov 501-454-5992
If you need to pay by check or PO, click NEXT,
then print your completed registration page and mail in to:

AUTIS
PO BOX 3314
Little Rock, AR 72203
Registration Information:
Attendee First Name:
Attendee Last Name:
Title:
Organization:
Address:
City:
State:
Zip:
E-mail:
Telephone:
ex: (999) 999-9999
FAX:
Registration Fees:
Autis Members Conference Fee ($25)
Non Autis Members Conference Fee ($50)

$15.00 for each additional game attendee.