Register for Event – The Family Cafe

I am a:

Who is Submitting Registration?

First Name

Last Name

Email Address

Phone Number

Physical Address Line 1

Location data helps us get to know our audience

Physical Address Line 2

Location data helps us get to know our audience

City

Location data helps us get to know our audience

State

Location data helps us get to know our audience

Zip Code

Location data helps us get to know our audience

County

Only fill if you are a resident of Florida

Number of Party Members Attending

Names of each of the extra party members can be added on the next page of this form

Ethnicity

Primary Language is:

(Military Information) I am, or was, a member of

Fill in only if member of Military

Military Component

Accommodations Required

Language Interpreter (Language)

I or a member of my family am/are currently on a waiting list for services from a State Agency:

If Other, Please Describe

I/a member of my family am/is an ABLE United account holder and/or administrator.

I/my family members am/are a Social Security Administration (SSA) beneficiary

How many family member(s) are SSA beneficiaries

If you/they are an SSA beneficiary, are you/they between the ages of 18-64 and receiving Supplemental Security Income (SSI) and/or Social Security Disability Income (SSDI)?

The success of The Annual Family Café relies on the help of our many generous volunteers. Please consider helping us out this year, by volunteering for one of the following:

If you want to volunteer as a Language Interpeter, what language can you interpret?

I Require Financial Assistance for (Only fill out if assistance is required)

In order to qualify, you must be a person with a disability or their family member residing in Florida, and you must live in a community that is located more than 50 miles from the City of Orlando. Funding will be distributed according to State of Florida guidelines. Applicants will be notified of their status by mail in April, 2020. NOTE: All Assistance is based on the availability of funding and awarded by lottery.

FOR PROFESSIONALS ONLY

I am a Professional and I will pay the $200 professional registration fee.

Individuals attending in a professional capacity are required to pay a Professional Registration Fee. Those that are individuals with disabilities or their immediate family members / caregivers are exempt. Checking this box is your acknowledgement of your obligation to pay the Professional Registration Fee if applicable. Payment can be made by to The Famly Cafe by Check or Purschase Order, or via Credit Card by accessing the PayPal link below.

Click this link to go to The Family Café's Paypal

Cancellation Policy

We are sorry, but there will be no refunds issued for cancellations. Substitutions are permitted. Remember, registration fees do NOT cover hotel costs. If you have questions about the payment procedure or the event in general, call The Family Cafe office at 888-309-2233 (CAFE).

Register for
The 23rd Annual Family Cafe

Cancellation Policy

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Register for The 23rd Annual Family Cafe

Cancellation Policy

Register for
The 23rd Annual Family Cafe