acrm 98th annualconference core: 26 9 sept 2021 interd …

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www.ACRM.org Questions? Looking for help? Please call +1.703.435.5335 or [email protected] REG FORM PG 1 MS MR REGISTRATION DATE REGISTER online at www.ACRM.org/register OR complete this form and submit via email, fax or mail (see last page). > ¨ First-time attendee ¨ ACRM is grateful for the generous support of our Conference" Sponsors and Exhibitors and plans to introduce attendees to"the value they offer via a small number of informative emails"prior to the conference. Check here to opt-out of these emails. CONTACT INFORMATION REGISTRATION OPTIONS There are 3 routes to register: 1) 6-Day World Pass 2) CORE & more 3) Instructional Course Pass WHAT SESSION(S) WILL YOU BE PRESENTING? (Select all that apply) I am not presenting this year Symposium Poster Oral Paper Instructional Course (Pre-Conference) Early Career Development Course (Pre-Conference) Leadership Development Course (Pre-Conference) Plenary or Special Symposium LaunchPad > ATTENDEE TYPE (Select One) Consumer Member Early Career Member Professional Member Student/Resident/Fellow Member ACRM COMMUNITY GROUPS CORE: 26 – 29 SEPT 2021 PRE-CONFERENCE: 24 – 26 SEPT INT ERD ISC IP L INA RY ACRM 98 th Annual Conference PROGRESS IN REHABILITATION RESEARCH # ACRM2021 > Are you attending any COMMUNITY GROUP MEETINGS? Yes > Consumer Non-Member Early Career Non-Member Professional Non-Member Student/Resident/Fellow Non-Member Non-member registration includes 6-month introductory ACRM membership. Please select the ACRM groups that are most relevant to you, so we may introduce you to opportunities and benefits available. You will receive email communication for the groups that you select. You may opt out of these emails anytime. Aging Research & Geriatric Rehabilitation Networking Group Arts & Neuroscience Networking Group Athlete Development & Sports Rehabilitation Networking Group Behavioral Health Group (New Forming) Brain Injury Interdisciplinary Special Interest Group (BI-ISIG) Cancer Rehabilitation Networking Group Career Development Networking Group Complementary, Integrative Rehabilitation Medicine Networking Group Health Services Research Networking Group International Networking Group Lifestyle Medicine Networking Group Limb Care Networking Group Measurement Interdisciplinary Special Interest Group (M-ISIG) Military / Veterans Affairs Networking Group Neurodegenerative Diseases Networking Group Neuroplasticity Networking Group Pain Rehabilitation Networking Group Pediatric Rehabilitation Networking Group Physicians and Clinicians Networking Group Rehabilitation Treatment Specification Networking Group Spinal Cord Injury Interdisciplinary Special Interest Group (ISIG) Stroke Interdisciplinary Special Interest Group (ISIG) Technology Networking Group Please make your selections on the following pages >> EARLY BIRD DR PROF First Name Zip/Postal Code Last Name Credential (degrees) Title Organization Email Mailing Address line 1 Mailing Address line 2 City, State Country Phone Emergency Contact Name Emergency Contact Phone No

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www.ACRM.org Questions? Looking for help? Please call +1.703.435.5335 or [email protected] FORM PG 1

MS MR

REGISTRATION DATE

REGISTER online at www.ACRM.org/register OR complete this form and submit via email, fax or mail (see last page).

>

¨ First-time attendee

¨ ACRM is grateful for the generous support of our Conference"Sponsors and Exhibitors and plans to introduce attendees to"thevalue they offer via a small number of informative emails"prior tothe conference. Check here to opt-out of these emails.

CONTACT INFORMATION

REGISTRATION OPTIONSThere are 3 routes to register:

1) 6-Day World Pass2) CORE & more3) Instructional Course Pass

WHAT SESSION(S) WILL YOU BE PRESENTING? (Select all that apply)

I am not presenting this year SymposiumPoster Oral Paper Instructional Course (Pre-Conference)Early Career Development Course (Pre-Conference) Leadership Development Course (Pre-Conference) Plenary or Special Symposium LaunchPad

>

ATTENDEE TYPE (Select One) Consumer Member Early Career Member Professional MemberStudent/Resident/Fellow Member

ACRM COMMUNITY GROUPS

CORE: 26 – 29 SEPT 2021 PRE-CONFERENCE: 24 – 26 SEPT I N T E R D I S C I P L I N A R YACRM 98th Annual Conference

PROGRESS IN REHABILITATION RESEARCH #ACRM2021

> Are you attending any COMMUNITY GROUP MEETINGS?

Yes

>

Consumer Non-Member Early Career Non-Member Professional Non-MemberStudent/Resident/Fellow Non-Member

Non-member registration includes 6-month introductory ACRM membership.

Please select the ACRM groups that are most relevant to you, so we may introduce you to opportunities and benefits available.

You will receive email communication for the groups that you select. You may opt out of these emails anytime.

Aging Research & Geriatric Rehabilitation Networking Group

Arts & Neuroscience Networking Group

Athlete Development & Sports Rehabilitation Networking Group Behavioral Health Group (New Forming)

Brain Injury Interdisciplinary Special Interest Group (BI-ISIG)

Cancer Rehabilitation Networking Group

Career Development Networking GroupComplementary, Integrative Rehabilitation Medicine Networking Group Health Services Research Networking GroupInternational Networking Group

Lifestyle Medicine Networking Group

Limb Care Networking Group

Measurement Interdisciplinary Special Interest Group (M-ISIG)

Military / Veterans Affairs Networking Group

Neurodegenerative Diseases Networking Group

Neuroplasticity Networking Group

Pain Rehabilitation Networking Group

Pediatric Rehabilitation Networking Group

Physicians and Clinicians Networking Group

Rehabilitation Treatment Specification Networking Group

Spinal Cord Injury Interdisciplinary Special Interest Group (ISIG)Stroke Interdisciplinary Special Interest Group (ISIG)Technology Networking Group

Please make your selections on the following pages >>

EARLY BIRD

DR PROF

First Name

Zip/Postal Code

Last Name

Credential (degrees)

Title

Organization

Email

Mailing Address line 1

Mailing Address line 2

City, State

Country

Phone

Emergency Contact Name

Emergency Contact Phone

No

conni
Cross-Out

www.ACRM.org Questions? Looking for help? Please call +1.703.435.5335 or [email protected] FORM PG 2

Please check the boxes for all activities you wish to include in your WORLD PASS

3.5 DAY CORE PASS

6-DAYWORLD PASS

WORLD PASS

PURCHASERSPlease check the boxes for all activities you

wish to add on in your WORLD PASS purchase

$399 - 579 $599 - 779(Prices in parenthesis below indicate the Early Bird costs if purchased separately.)

CORE CONFERENCE ($349/one-day student - $579/3.5 day professional) Educational Symposia SUN – WED: 300+ sessions & lectures 4 Plenary Sessions Moderated Panel Discussions Awards Lectures Scientific Posters — hundreds! ACRM Community Group Meetings: Interdisciplinary Special Interest Groups (ISIGs), Networking Groups, Task Forces and Committees. A few are invitation only. 400+CME/CEU credits

VIRTUAL ACRM EXPO: Poster Grand Rounds Live Video Chats with vendors Learning Center

PRE-CONFERENCE

INSTRUCTIONAL COURSES ($169 - 279) additional fee Early Career Development Course: SUN ($349 - 499) additional fee

Conference Slides / PDFs Digital access to all available symposia and pre-conference instructional course slide presentations (PDFs). A few content leaders elect not to have their slides available to attendees, therefore some sessions may not be included. Cognitive Rehabilitation Training and Early Career Development Course are not included.

3.5 days of sessions

6-days of sessions

PASS COMPARISON

I N T E R D I S C I P L I N A R YACRM 98th Annual ConferencePROGRESS IN REHABILITATION RESEARCH #ACRM2021

CORE: 26 – 29 SEPT 2021 PRE-CONFERENCE: 24 – 26 SEPT

Leadership Development Course: SUN ($349 - 499) additional fee

www.ACRM.org Questions? Looking for help? Please call +1.703.435.5335 or [email protected] FORM PG 3

STUDENT / RESIDENT / FELLOW CONSUMER / NON-PROFESSIONAL CAREGIVER

PAID MEMBER 599 749 849

NON-MEMBER 699 849 949

EARLY CAREERPAID MEMBER 699 849 949

NON-MEMBER 799 949 1,049

PROFESSIONALPAID MEMBER 779 949 1,349

NON-MEMBER 879 1,049 1,449

BEST VALUE

CORE + PRE-CONFERENCEINCLUDES: VIRTUAL ACCESS to all CORE Conference sessions including symposia, plenaries, featured sessions, awards lectures, ACRM Community Group Meetings, poster and papers, PLUS all Pre-Conference courses (40+), CME/CEUs credits, and full access to actionin the ACRM Virtual EXPO.

WO

RLD

PA

SS

6-D

AY

WORLD PASS6-DAY

STUDENT / RESIDENT / FELLOWCONSUMER / NON-PROFESSIONAL CAREGIVER

PAID MEMBER

NON-MEMBER

EARLY CAREERPAID MEMBER

NON-MEMBER

PROFESSIONALPAID MEMBER

NON-MEMBER

SUN 2:10 PM THROUGH WED 26 - 29 SEPT3.5

DAY

3.5-DAY CORE PASS

I N T E R D I S C I P L I N A R YACRM 98th Annual ConferencePROGRESS IN REHABILITATION RESEARCH #ACRM2021

INCLUDES: VIRTUAL-ONLY access to all sessions SUN afternoon through WED including symposia, plenaries, featured sessions, awards lectures, ACRM community group meetings, posters, CME/CEU credits, and full access tothe ACRM VIRTUAL EXPO. & Learning Center including

CORE: 26 – 29 SEPT 2021 PRE-CONFERENCE: 24 – 26 SEPT

ON-SITE

399449529629

579679

499549649749729829

599649849949

1,1491,299

STUDENT / RESIDENT / FELLOW CONSUMER / NON-PROFESSIONAL CAREGIVER

PAID MEMBER 349 409 489NON-MEMBER 399 469 589

EARLY CAREERPAID MEMBER 389 449 519NON-MEMBER 469 549 619

PROFESSIONALPAID MEMBER 429 499 549NON-MEMBER 499 579 649

1-DA

Y

Select SUN AFTERNOON MON, TUES, or WED INCLUDES: ONE day of VIRTUAL access to all sessions scheduled on the day selected, CME/CEU credits, and full access to action in the ACRM Virtual EXPO.

1-DAY CORE PASS

CME/CEU processing is included with registration. Please select all that you will be claiming:○ ABCOP (limb loss) (new as of 2021)○ Case Managers (CCMC)○ Dietitians (CDR)○ Disability Management Specialists (CDMS

Commission)○ Health Care Executives (ACHE)

○ Nurses (ANCC)○ Occupational Therapists (AOTA)○ Physicians (ACCME, includes Canada Physicians

and Physician Assistants)○ Psychologists (APA Division 22 Accreditation)○ Rehabilitative Counselors (CRCC)

○ Social Workers (NASW)○ Speech-Language Professionals (ASHA)○ Physical Therapists (FSBPT and remaining

individual States approvals)○ Massage and Body Works (NCBTMB)

SELECT ONE: SUN MON TUES or WED

EARLY BIRD REGULAR ON-SITE

CLICK HERE for the latest deadlines

CLICK HERE for the latest deadlines

CLICK HERE for the latest deadlines

ONSITEEARLY BIRD REGULAR

REGULAREARLY BIRD

www.ACRM.org Questions? Looking for help? Please call +1.703.435.5335 or [email protected] FORM PG 4

I N T E R D I S C I P L I N A R YACRM 98th Annual ConferencePROGRESS IN REHABILITATION RESEARCH #ACRM2021

INSTRUCTIONAL COURSE PASS (PRE-CONFERENCE)

EARLY BIRD REGULAR ON-SITE

PAID MEMBER 169 199NON-MEMBER 199

PAID MEMBER 229 269 319NON-MEMBER 319 389

Choose from dozens of half-day and full-day courses on a wide variety of topics — see next page. All Instructional Courses are INCLUDED in the WORLD PASS.

4-HOUR

4-HOUR INSTRUCTIONAL COURSESELECT ONE: FRI SAT or SUNINCLUDES: CME/CEU credits, available slides for course selected

ACRM.org/preconference

PAID MEMBER ¨ 279 ¨ 349 ¨ 439NON-MEMBER ¨ 349 ¨ 439 ¨ 549

2.5 DAYS INSTRUCTIONAL COURSE PASSINCLUDES: FRI, SAT and SUN INCLUDES: CME/CEU Credits, all available Instructional Course slides

CORE: 26 – 29 SEPT 2021 PRE-CONFERENCE: 24 – 26 SEPT

8-HOUR INSTRUCTIONAL COURSESELECT ONE: FRI SAT or SUNINCLUDES: CME/CEU credits, available slides for course selected

8-HOUR

2.5 DAYS

EARLY BIRD REGULAR ON-SITE

PAID MEMBER 349 399 499

NON-MEMBER 449 499 599

EARLY CAREER DEVELOPMENT COURSE

Early Career Development Course: Virtual registration includes CME/CEU credits. This session connects early career rehabilitation researchers with seasoned professionals who serve as mentors to answer specific questions regarding career development and funding OPPORTUNITIES. This is included in the WORLD PASS.

(This course IS included in WORLD PASS)

ACRM.org/ecdc

EARLY CAREER DEVELOPMENT COURSE

EARLY BIRD REGULAR ON-SITE

PAID MEMBER 349 399 499

NON-MEMBER 449 499 599

LEADERSHIP DEVELOPMENT COURSE

Leadership Development Course: Virtual registration includes CME/CEU credits. This course is designed to help rehabilitation and research professionals begin to develop leadership skills necessary to advance and build the leadership capacity in rehabilitation medicine and research.

(This course IS included in WORLD PASS)

ACRM.org/ldc

LEADERSHIP DEVELOPMENT COURSE

249249319

269

CLICK HERE for the latest deadlines

CLICK HERE for the latest deadlines

CLICK HERE for the latest deadlines

Instructional Courses

TWO-DAY INSTRUCTIONAL COURSE

Al l courses below are INCLUDED in the WORLD PASS. Continuing education credits and conference slides are incl uded. A few content leaders elect not to have their slides available to attendees, therefore some sessions may not be included.

FRI - S AT 24 - 25 SEPT

ICIOA & B Emerging Concepts & Evidence Basis behind Novel Approaches to Managing Chronic Spinal Pain PAIN CP INT NP TEC

FRIDAY 24 SEPT

MORNING 10:00 AM - 2:00 PM 1c2 Concussion: A Vestibular & Ocular Focus for the Treating Clinician (Intermediate Level) CP ATH 81

1cs Hanging by a Thread During Covid-19 Pandemic- Best Practices to Mitigate Frailty for At-Risk Community Dwelling Elderly GER COVID-19 LM

IC6 Responding to Racism, Discrimination, and Microaggressions in Academic Medicine CULTIJRAL COMPETENCT ETHICS

1ca Culinary Coaching Instructional Course LM ATH Bl BHI CAN CP

FULL DAY 10:00 AM - 6:30 PM IC3 A Non Pharmacological Framework for �ent & Treatment to Reduce Pain & Sp.,sticity in Neurological Adult & Pediatric Patients CP Bl GER

IC7 Innovations in Limb Loss and Difference Rehabilitation LR BHS CP

IC9 Integrating Patient Reported Outcomes (PRO) in Rehabilitation Clinical Practice MEAi Bl CP

1c1 I Smartphone Apps for Day-to-Day Management of Executive Function Issues TEC Bl BHI MIL ND PAIN

IC48 ACRM 2021 Integrative Rehabilitation Research Mentoring & Career Development Fellowship for early career researchers CULTURAL COMPETENCY from underrepresented & diverse backgrounds

AFTERNOON 2:30 PM - 6:30 PM ICl2 Post-Traumatic Headaches

ICl4 "Keep Your Move in the Tube": An Evidence-Based Clinical Approached Implementation of a New Paradigm for Management of Cardiac Patients After Sternotomy

1c1s American Spinal Injury Association l/2 day at the ACRM Annual Conference 2021

81 CP

CP

SCI CP PAIN

SATURDAY 25 SEPT

MORNING 10:00 AM - 2:00 PM ET ICl9 FES Cycling & Stepping Interventions to Optimize Outcomes in Persons w/ Neurological Disorders CP ND SCI TEC

IC2 I Rehabilitation Treatm:nt Specification System: Principles & Application in Rehabilitation Education, Research & Clinical Practice CP

IC22 Facilitating Implementation Science in Practice: Secrets of Successful Clinical and Research Partnerships HSR CP

IC23 Longitudinal Data Analysis & Practical Workshop Using R: Part I Introductory Topics MEAi Bl GER HSR ND PED

IC27 Different Paradigms of Electrical Stimulation for Neuromuscular Recovery after Spinal Cord Injury SCI NP

IC36 Management of Vision Deficits Following Acquired Brain Injury Bl CP

FULL DAY 10:00AM - 6:30 PM ICl6 Behavioral Health Group Intervention -An Interactive Workshop BHI CP

ICl7 Introduction to Applying Integrative Cognitive Rehabilitation Psychotherapy to Brain Injury with Co-Occurring Issues 81 BHI CP

1c1a Disorder of Consciousness: The Implementation of Guideline Recommendations for Interdisciplinary Bl CP Clinical Rehabilitation Practice: An Interactive Course

IC25 Uncovering the Obstacles-Using Uniform Terminology to Identify Contextual & Environmental Factors that Affect Participation MEAi CP HSR

IC26 Optimizing Pediatric NeuroRecovery: Benefits of Early Intervention and Activity-Based Therapy PED 81 SCI

IC28 Interdisciplinary Perspectives to Functional Measurement and Assessment of the Stroke Survivor CP

TEC IC29 The User Experience & Usability Research: In-depth look at Interviews, Observational Studies & Usability Testing

AFTERNOON 2:30 PM - 6:30 PM IC24 Longitudinal Data Analysis & Practical Workshop Using R: Part II Advanced Topics 81 GER HIR ND SCI

IC30 Improving Carry-Over: A Practical Lab on Approaches for Translating Therapeutic Gains Into Daily Activities

IC31 Bench to Bedside: A Guide for Implementing Evidence Based Interventions into Practice at Organizational Level

IC32 Home Evaluations for Safe Discharge and Aging-in-Placel

IC33 Rehabilitation for Functional Movement Disorders: The Works

IC34 Restoring Voluntary Grasping Function After Stroke or Spinal Cord Injury Using Functional Electrical Stimulation

SUNDAY 26SEPT

MORNING 10:00 AM - 2:00 PM ET 1c20 A Guide to Best-Practice Interdisciplinary Goal Setting in Clinical Practice

IC35 Rhythm & the Motor System: New Opportunities for Gait Tra ining

IC37 So You Want to be a TBI Expert Witness?

IC38 Interdisciplinary Care for Concussion/Mild Traumatic Brain Injury: A Model for Differential Diagnosis & Management

IC39 Comprehensive Management of Head & Neck Cancer: Optimizing Outcomes Through a Multi-Disciplinary Approach

IC40 Learn how Alexander Technique Interventions Can Complement & Enhance Rehabilitation Research & Interdisciplinary Clinical Practice

IC41 Practice Skills for Rehabilitation Professionals Working With Refugees and Asylum Seekers

IC42 How to Effectively Use Secondary Data in Your Research Program

IC44 NIH Toolbox: Innovative Assessments for the Rehab

IC45 Optimizing Upper Extremity Reconstruction After Spinal Cord Injury: An Interdisciplinary, Systematic & Iterative Approach

IC46 Functional Assessment and Prism Adaptation Treatment for Spatial Neglect after Stroke

IC47 Powering Forward: Wheelchair Setup and Skills for Power Wheelchair Users

CP BHI ND NP

CP Bl SCI

CP GER

CP

TEC CP NP

CP Bl COVID-19

AN CP TEC

81 ETHICS

81 ATH CP

CAN BHS TEC

ATH Bl CP

CP INT

HSR

MEAi BHI

SCI CP TEC

Bl CP

TEC Bl CP GER

TEC

m!II AN: Arts & Neuroscience ATH: Athlete Development & Rehabilitation BHI: Behavioral Health Sciences Bl: Brain Injury Rehabilitation CAN: CANcer rehabilitation CRO i i-CUTTiNG / CC: Spanning Diagnoses IMill II Complementary, lntegra tivo, Rehabilitation Medicine CP: Clinical Practice GER: GERiatric Rehabilitation HSR: Heal th Services Research INT: INT,rnational LR: limb Care LM: lifestyle Medicine MEAS: MEAlurement Mil: Military/veterans affairs ND: Neurodegenerative Disease (e.g. Ml, Parkinson's disease) NP· NeuroPlasticity (includes neuroscience) PAIN: PAI N rehabilitation PED: PEDiatric rehabilitation QUAL: QUAlity Improvement & Implementation Science RT Rehabilitation Research Specifications SCI: Spinal Cord Injury Stroke Rehabilitation TEC: TEChnology (robotics, assistive technology, mHealth)

+1.703.435.5335 ACRM 98th An nual Conference PRE-CON: 24 - 26 SEPT 2021

CORE CON: 26 - 29 SEPT 2021

I N T E R D I S C I P L I N A R YACRM 98th Annual ConferencePROGRESS IN REHABILITATION RESEARCH #ACRM2021

CORE: 26 – 29 SEPT 2021 PRE-CONFERENCE: 24 – 26 SEPT

www.ACRM.org Questions? Looking for help? Please call +1.703.435.5335 or [email protected] FORM PG 5

www.ACRM.org Questions? Looking for help? Please call +1.703.435.5335 or [email protected] FORM PG 6

STUDENT / RESIDENT / FELLOW: Attendees enrolled in an accredited school of medicine or approved graduate or undergraduate program or fellowship in a medical rehabilitation discipline.

EARLY CAREER: Professionals during first five years after completion of post-graduate studies.

REHABILITATION PROFESSIONAL: Professionals in medical rehabilitation or a related field who are actively engaged in the practice, administration, education or research of medical rehabilitation.

CONSUMER / NON-PROFESSIONAL CAREGIVER: People with disabilities and caregivers who use rehabilitation services and/or research.

MEMBER: ACRM paid members enjoy savings on ACRM products and events, including annual conference registration. Visit www.ACRM.org/join to become a member and start saving. To receive the Member Rate, one must be an active ACRM Member (not a Special Interest or Networking Group member only) on the day of registration.

NON-MEMBER: A person without a current ACRM membership on the date of registration.

TRANSACTION POLICIES

SUBSTITUTIONS / TRANSFERS BETWEEN REGISTRANTS: Registrants wishing to transfer their registration to another individual must submit a written request/email to [email protected]. Instructional Courses are non-transferable. A substitution fee of $249 USD will be charged against the original registration on transfer requests received before 1 August 2021. No substitutions will be made on or after 1 August 2021. Those who register as non-members retain their 6-month ACRM membership.

CONFERENCE CANCELLATION BY REGISTRANT: ACRM is a non-profit organization. Registrants wishing to cancel their registration and receive a refund for items other than Instructional Courses must submit a written request to [email protected]. Instructional Courses are non-refundable. A cancellation fee of $249 USD will be charged on cancellation requests received on or before 31 May 2021 and the balance remaining will be refunded. On or after 1 June 2021, a cancellation fee of $249 USD or 50% of registration paid, whichever is greater, will be charged and the balance paid will be refunded. If the registration paid is less than or equal to $249, no refund will be given. No refunds will be made on or after 1 August 2021. Those who register as non-members retain their 6-month ACRM membership. Registrants wishing to cancel their course registration (ECDC) and receive a refund for items other than Instructional Courses must submit a written request to [email protected]. Instructional Courses are non-refundable. A cancellation fee of $199 USD or 50% of the course fee, whichever is greater will be charged on cancellation requests received on or before 31 July 2021. No refunds will be made on or after 1 August 2021. Those who register as non-members retain their 6-month ACRM membership.

TYPES OF PAYMENT: Credit card (MasterCard, VISA, American Express, Discover), check/money order (U.S. funds only) made payable to ACRM, wire transfer for an additional $25 fee.

PAYMENT DECLINED: If a credit card payment is declined or a check is returned, the registrant will be notified and an alternative method of payment will be requested. A $15 USD processing fee will be applied for re-billing of a credit card and/or returned checks.

RATE INFO

TERMS & CONDITIONS

I N T E R D I S C I P L I N A R YACRM 98th Annual ConferencePROGRESS IN REHABILITATION RESEARCH #ACRM2021

COURSE CANCELLATION BY REGISTRANT FOR COGNITIVE REHABILITATION TRAINING (CRT), AND/OR EARLY CAREER DEVELOPMENT COURSE (ECD): Registrants wishing to cancel their course registration (CRT, ECD) and receive a refund for items other than ICs must submit a written request to [email protected]. ICs are non-refundable. A cancellation fee of $199 USD or 50% of the course fee, whichever is greater, will be charged on cancellation requests received on or before 31 August 2021. No refunds will be made on or after 1 September 2021. Those who register as non-members retain their 6-month ACRM membership.

CORE: 26 – 29 SEPT 2021 PRE-CONFERENCE: 24 – 26 SEPT

www.ACRM.org Questions? Looking for help? Please call +1.703.435.5335 or [email protected] FORM PG 7

TERMS AND CONDITIONS

FORCE MAJEURE: In the event of a full or partial cancellation of the ACRM Annual Conference due to a natural disaster or other force beyond the control of ACRM, ACRM will refund registrations in proportion with the cancellation insurance proceeds it receives.

RECORDING BY ATTENDEES: Recording or photographing conference sessions by an attendee, panel discussions or sponsor exhibits is strictly prohibited.

ETIQUETTE: To make the conference experience an enjoyable event for all attendees, we ask that you keep the following in mind: Ensure that all comments within the online virtual networking are professional and respectful of all attendees and presenters.

SOLICITATION: By registering, you agree not to solicit vendors or exhibitors

STATEMENT OF LIABILITY WAIVER — TERMS OF REGISTRATION: ACRM or any other conference sponsor claims no liability for the acts of any suppliers at or to the meeting, or for the safety of any registrant while in transit to or from this event. ACRM shall not be liable for any delays or failure in performance or interruption of services resulting directly or indirectly from any cause or circumstance beyond the reasonable control of the organization including but not limited to, acts of God, pandemic, acts of public enemy, war, accidents, fires, electrical failures, strikes, labor disputes, postal delays, explosions, governmental order or regulations.

ACRM reserves the right to cancel the conference or any function without liability. Registrants who purchased non-refundable airline tickets do so at their own risk. The total amount of any liability of ACRM will be limited to a refund of the registration fee.

By attending the conference, the registrant agrees to indemnify and hold harmless ACRM, other conference sponsors, their respective officers, directors, and agents, against all claims arising out of actions or omissions of the supplier, attendee, or other individual at or in connection with the conference except for ACRM’s or any other sponsor’s own gross negligence or willful misconduct.

ACRM or any other conference sponsor reserves the right to substitute an equally qualified speaker in case of an emergency or cancellation.

ACRM or any conference sponsor has no duty of due diligence with respect to presenters, exhibitors, or sponsors, and makes no endorsements of any presentation or product.

Sessions, events, and exhibits can only be attended by registered attendees.

PLEASE CHECK! I have read and agree to the Terms & Conditions above and on previous page

I N T E R D I S C I P L I N A R YACRM 98th Annual ConferencePROGRESS IN REHABILITATION RESEARCH #ACRM2021

CORE: 26 – 29 SEPT 2021 PRE-CONFERENCE: 24 – 26 SEPT

COMMUNICATION: ACRM will assign registrants to the community groups according to the sessions that they sign up for. No action will be taken for registrants that are already part of the community group.

www.ACRM.org Questions? Looking for help? Please call +1.703.435.5335 or [email protected] FORM PG 8

Type of Payment Enclosed

Check/Money Order (US Funds Only) Check #__________Make check payable to: ACRM

Credit Card (fill out information below)MasterCard Visa ❏ American Express ❏Discover

Credit Card #:__________________________________________________

Expiration Date:__________________ Security Code:_______________

Print name as it appears on card:_____________________________________

Cardholder’s Signature: ___________________________________________

Cardholder’s e-mail address: _____________________________________

Check here if you want to bundle ACRMmembership/pay your dues renewal too.

2904

21

$___________TOTAL AMOUNT in USD < The sum from your selections on the previous pages.

EMAIL: [email protected] ORFAX: +1.866.692.1619 ORMAIL CHECKS TO: PROCESS CREDIT CARD FORMS TO: ACRM: PO Box 896700 email [email protected]

Charlotte, NC 28289-6700

PAYMENT

BILLING ADDRESS Check if same as mailing address on pg 1

SUBMIT

Address 1

Address 2

City

State / Province

Zip / Postal Code

Country

(to send confirmation)

www.ACRM.org

For questions related to the status of registrations, please contact [email protected] or phone: +1.703.435.5335

Online registration at:

?s

DISCOUNT CODE:____________________________________________

I F A P P L I C A B L E

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< If a colleague referred you to ACRM, please include their name so we may thank them!

I N T E R D I S C I P L I N A R YACRM 98th Annual ConferencePROGRESS IN REHABILITATION RESEARCH #ACRM2021

CORE: 26 – 29 SEPT 2021 PRE-CONFERENCE: 24 – 26 SEPT