2018 Annual Conference Registration


Notice: A separate registration is required for each person attending.

*First Name:
*Last Name:
  Mr.   Mrs.  Ms.
*Complete Home mailing address:
Number of Years
in Direct Care:
*Home phone:
Work phone:
Cell phone:
Employer Address:
Employer City:
Employer State:
Employer Zip:
Is this your first time
at conference?
Yes    No
Do you plan to participate in the health screenings? Yes    No
Do you have any special dietary needs? Yes    No
Please list here:

Please contact us at or 515-223-2805 by May 18 for any accommodations and/or alternative formats you may need.

      Please Select Your Occupation (check all that apply):
Certified Nursing Assistant (CNA) Consumer Directed Attendant Care (CDAC) worker
CNA plus other certification, such as medication aide, rehabilitation aide, etc. Direct Support Professional
Home Care Aide (HCA) Hospice Aide
Home Health Aide (HHA) Companion, non-medical assistant
Universal Worker Family Caregiver
Patient Care Technician (PCT) Other
If other, please specify
*Registration   $95 (one day)    $125 (both days)
Days you will be attending
(check all that apply)
   June 4    June 5
  If your registration is received after May 25, 2018, you will be charged an additional $30 special processing fee.