www.ACRM.org T: +1.703.435.5335PG 1

ADVANCE RATE

EARLY-EARLY BIRD EARLY BIRD REGULAR ON-SITE

PLEASE SEE THE ONLINE PRICING PAGE TO VIEW RATE CLOSING DATES:www.ACRM.org/2014-annual-conference/2014-pricing

ACRM MEMBER � 595 � 695 � 795 � 895 � 1,195NON-MEMBER � 795 � 895 � 995 � 1,095 � 1,395

RESIDENT / STUDENT / FELLOW ACRM MEMBER � 295 � 395 � 395 � 495 � 595 RESIDENT / STUDENT / FELLOW NON-MEMBER � 395 � 495 � 495 � 595 � 695

EARLY CAREER ACRM MEMBER � 295 � 395 � 395 � 495 � 595

EARLY CAREER NON-MEMBER � 395 � 495 � 495 � 595 � 695 DAY REGISTRATION ACRM MEMBER SELECT: £ THU £ FRI £ SAT � 350 � 450 � 550 � 650 � 750

DAY REGISTRATION NON-MEMBER SELECT: £ THU £ FRI £ SAT � 450 � 550 � 650 � 750 � 850

CME / CEU CREDITS OPTIONAL � 95 � 95 � 95 � 95 � 150Please select below the CME/CEU credits you require. One processing fee covers all credits for which you qualify. Because many ACRM attendees do not require annual CME/CEU credit, this fee is not included in registration. � Physician (ACCME), � Nurse (ANCC), � Case Manager (CCM), � Rehabilitation Psychology (APA Division 22), � Certified Rehab Counselors (CRCC), � Occupational Therapy (AMA PRA Category 1 Credit™), � Physical Therapy (AMA PRA Category 1 Credit™), � Speech Pathologist (ASHA), � Disability Management Specialist (CDMS), � Health Care Executives (ACHE), � Dieticians (CDR)

Registration Date ACRM COMMUNITY GROUPS 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:

� Brain Injury Interdisciplinary Special Interest Group (BI-ISIG) � Spinal Cord Injury Interdisciplinary Special Interest Group (SCI-ISIG) � Stroke Interdisciplinary Special Interest Group (STROKE-ISIG) � Cancer Networking Group � Early Career Networking Group � Geriatric Rehabilitation Group � Health Policy Networking Group � International Networking Group � Military / Veterans Affairs Networking Group � Neurodegenerative Diseases Networking Group � Outcomes Measurement Networking Group � Pain Rehabilitation Group � Pediatric Networking Group

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

CORE CONFERENCE: PLEASE CHECK ONE

ADVANCE RATE

EARLY-EARLY BIRD EARLY BIRD REGULAR ON-SITE

SAVE UP TO $685 SAVE UP TO $685 SAVE UP TO $730 SAVE UP TO $785 SAVE UP TO $1,085ACRM MEMBER � 795 � 995 � 1,050 � 1,095 � 1,395

NON-MEMBER � 995 � 1,195 � 1,250 � 1,295 � 1,595

WORLD PASS CORE CONFERENCE bundled with add-ons for HUGE SAVINGS OFF a la carte pricing

INCLUDES: access to all educational symposia, plenary sessions, moderated panel discussions, awards lectures and the ACRM Expo Thursday, Friday and Saturday, 9 – 11 October.

>

ATTENDEE TYPE � Rehabilitation Professional

� Early Career

� Resident / Student / Fellow

� Presenter (Instructional Course)

� Presenter (Symposia)

� Presenter (Paper/Poster)

� Exhibitor

� Consumer

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� Dr. � Mr. � Mrs. � Ms.

First Name

Last Name

Credentials

Specializations

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� Check here to opt out of receiving a small number of informative emails prior to the conference from ACRM on behalf of conference sponsors and exhibitors.

� First-time attendee

Money-saving, all-inclusive pass INCLUDES: core registration (below), CME/CEU credits, two ticketed lunches, gala ticket, and DVD of proceedings.

7 – 11 OCTOBER 2014PROGRESS IN

REHABILITATION RESEARCHACRM 91st Annual Conference

INTERCONTINENTAL, TORONTO CENTRE AND THE METRO TORONTO CONVENTION CENTRE TORONTO, ON, CANADA

www.ACRM.org T: +1.703.435.5335PG 2

PRE- AND POST-CONFERENCE ENHANCE YOUR EXPERIENCE and make the most ofyour travel time and expense by adding one or more in-deptheducational courses to your core conference registration.

COGNITIVE REHABILITATION TRAINING: TWO-DAY COURSE TUES – WED

ADVANCE RATE

EARLY-EARLY BIRD EARLY BIRD REGULAR ON-SITE

PLEASE SEE THE ONLINE PRICING PAGE TO VIEW RATE CLOSING DATES:www.ACRM.org/2014-annual-conference/2014-pricing

ACRM MEMBER � 395 � 495 � 595 � 695 � 795

NON-MEMBER � 495 � 595 � 695 � 795 � 895

RESIDENT / STUDENT / FELLOW ACRM MEMBER

� 295 � 395 � 495 � 595 � 695

RESIDENT / STUDENT / FELLOW NON-MEMBER

� 395 � 495 � 595 � 695 � 795

EARLY CAREER ACRM MEMBER � 295 � 395 � 495 � 595 � 695

EARLY CAREER NON-MEMBER � 395 � 495 � 595 � 695 � 795

COGNITIVE REHABILITATION TRAINING INCLUDES: Two days of evidence-based training; one printed copy of the ACRM Cognitive Rehabilitation Manual ($150 value); CME/CEU credits; six months of online access to a previously recorded Cognitive Rehabilitation Training.

PREVENTING & REVERSING VASCULAR DISEASE: TWO-DAY COURSE // TUESDAY – WEDNESDAY

ACRM MEMBER � 395 � 495 � 595 � 695 � 795

NON-MEMBER � 495 � 595 � 695 � 795 � 895

RESIDENT / STUDENT / FELLOW ACRM MEMBER

� 295 � 395 � 495 � 595 � 695

RESIDENT / STUDENT / FELLOW NON-MEMBER

� 395 � 495 � 595 � 695 � 795

EARLY CAREER ACRM MEMBER � 295 � 395 � 495 � 595 � 695

EARLY CAREER NON-MEMBER � 395 � 495 � 595 � 695 � 795

VASCULAR DISEASE COURSE INCLUDES: Two days of evidence-based training; CME/CEU credits. Non-members receive 6-month introductory ACRM membership with a subscription to the journal, Archives of Physical Medicine and Rehabilitation.

EARLY CAREER DEVELOPMENT COURSE: FULL-DAY // WEDNESDAY

ACRM MEMBER � 95 � 195 � 295 � 395 � 495

NON-MEMBER � 195 � 295 � 395 � 495 � 595

EARLY CAREER DEVELOPMENT COURSE INCLUDES: Early Career Reception following the course.

HALF-DAY COURSES WED & SATIncludes CME/CEU credits

ADVANCE RATE

EARLY- EARLY BIRD EARLY BIRD REGULAR ON-SITE

PLEASE SEE THE ONLINE PRICING PAGE TO VIEW RATE CLOSING DATES:www.ACRM.org/2014-annual-conference/2014-pricing

ACRM MEMBER ONE / TWO / THREE COURSES

100 / 160 / 210£1 / £2 / £3

145 / 232 / 305£1 / £2 / £3

195 / 312 / 410£1 / £2 / £3

245 / 392 / 515£1 / £2 / £3

295 / 472 / 620£1 / £2 / £3

NON-MEMBER ONE / TWO / THREE COURSES

150 / 210 / 260£1 / £2 / £3

195 / 282 / 355£1 / £2 / £3

245 / 362 / 460£1 / £2 / £3

295 / 442 / 565 £1 / £2 / £3

345 / 522 / 670 £1 / £2 / £3

INSTRUCTIONAL COURSES Please make your course selections on the next page.

7 – 11 OCTOBER 2014PROGRESS IN

REHABILITATION RESEARCHACRM 91st Annual Conference

INTERCONTINENTAL, TORONTO CENTRE AND THE METRO TORONTO CONVENTION CENTRE TORONTO, ON, CANADA

www.ACRM.org T: +1.703.435.5335PG 3

INSTRUCTIONAL COURSES Please make your course selections here. Pricing on previous page.

WEDNESDAY // PRE-CONFERENCE

FULL DAY 8:00 AM – 5:00 PM� 1) Coping Skills Training for Survivors of Brain Injury and Caregivers: A Workshop PART I / TBI � 1) CONTINUED Coping Skills Training for Survivors of Brain Injury and Caregivers: A Workshop PART II / TBI

MORNING COURSES 8:00 AM – 12:00 PM� 2) Fatigue in Traumatic Brain Injury: Current State of Knowledge and Future Direction / TBI � 3) Evidence, Expertise and Applicability: Key Lessons in Development and Implementation of TBI Clinical Practice Guidelines / TBI � 4) Getting Fit & Staying Active: Promoting Long-Term Health and Fitness in the SCI Community / SCI � 5) Functional Electrical Stimulation for Gait: A Clinical Update in Neurorehabilitation / STROKE� 6) Multimorbidity and Secondary Health Conditions after SCI: Critical Insights and Advances From the North / SCI � 7) The Role of Physical Therapy Across the Patient Care Continuum in Pediatric Oncology / CANCER � 8) Cancer Rehabilitation: An Update and Discussion of Future Care / CANCER � 9) An Introduction to Longitudinal Data Analysis: PART I Continuous Outcomes / Cross-cutting � 10) Harmonizing the Measurement of Function: From the Acute Hospital Throughout Post-Acute Care / Cross-cutting � 11) Everything You Wanted to Know about 2014 CARF Standards and Process and Much More / CARF

AFTERNOON COURSES 1:00 PM – 5:00 PM� 12) Inter-professional Clinical Practice Guideline For Vocational Evaluation Following Traumatic Brain Injury – Development, Implementatio / TBI � 13) A Canadian Brain Injury Rehabilitation: Centre for Excellence — Current and Future Directions / TBI � 14) Advanced Symposium on Teaching the International Standards for Neurological Classification of Spinal Cord Injury / SCI � 15) Mental Practice for Movement After Stroke: An Instructional Course for Clinicians / STROKE� 23) An Overview of Pediatric Multiple Sclerosis / NEURODEGENERATIVE DISEASES� 16) Cancer Rehabilitation: Utilization of Inpatient Rehabilitation for the Oncology Patient / CANCER � 17) An Introduction to Longitudinal Data Analysis: PART II Non-Continuous Outcomes / Cross-cutting � 18) Solving Business and Clinical Dilemmas While Retaining Quality / CARF� 19) Building a Research Culture in a Clinical Setting / CARF

SATURDAY // POST-CONFERENCE

MID-DAY COURSE 10:00 AM – 2:00 PM Box lunch provided for these Saturday courses � 20) A Multidisciplinary Approach in the Management of Sports Concussion / TBI � 21) Physician Investigator Basic Training Cancer / Cross-cutting � 22) Ensuring the Delivery of High-Quality Fall Prevention: How Rehabilitation Professionals Engage in Quality Improvement / Cross-cutting

Please check for scheduling course conflicts when registering for any pre-conference events/courses (including Cognitive Rehabilitation Training Early Career Development Course and Instructional Courses.)

KEY DIAGNOSTIC AREAS

BR AIN INJURY SPINAL CORD

INJURY C ANC ER C ARFVASCUL AR

HE ALTHCROSS -

CUT TINGPAINNEURO -

DEGENER ATIVE DISE ASES

STROK E

7 – 11 OCTOBER 2014PROGRESS IN

REHABILITATION RESEARCHACRM 91st Annual Conference

INTERCONTINENTAL, TORONTO CENTRE AND THE METRO TORONTO CONVENTION CENTRE TORONTO, ON, CANADA

www.ACRM.org T: +1.703.435.5335PG 4

ADVANCE RATE

EARLY-EARLY BIRD EARLY BIRD REGULAR ON-SITE

PLEASE SEE THE ONLINE PRICING PAGE TO VIEW RATE CLOSING DATES:www.ACRM.org/2014-annual-conference/2014-pricing

ATTENDING ACRM MEMBER � 95 � 195 � 195 � 195 � 295

NON-ATTENDING ACRM MEMBER � 395 � 495 � 495 � 495 � 595

NON-ATTENDING NON-MEMBER � 545 � 645 � 645 � 645 � 745

DVD OF PROCEEDINGS Includes the Powerpoint presentations of the educational symposia of the core conference plus the half-day Instructional Courses.

Does not include the two-day courses: Cognitive Rehabilitation Training and Vascular Disease.

TICKETED EVENTS ADVANCE RATE

EARLY-EARLY BIRD EARLY BIRD REGULAR ON-SITE

BRUCKER INTERNATIONAL LUNCHEON WITH SPEAKER // THU 12:30 PM � 50 � 50 � 50 � 50 � 95

SCI-ISIG LUNCHEON WITH SPEAKER // FRI 12:30 PM � 50 � 50 � 50 � 50 � 95

NDD LUNCHEON WITH SPEAKER // THU 12:30 PM � 50 � 50 � 50 � 50 � 95 HENRY B. BETTS AWARDS GALA // FRIDAY NIGHT � 95 � 95 � 95 � 95 � 150

GUEST TO GALA � 95 � 95 � 95 � 95 � 150

Below events are INCLUDED with core conference registration. Please CHECK the events you plan to attend to help event planning.

MOVIE SCREENING: FORKS OVER KNIFES // OPEN TO PUBLIC // TUES PM � COST INCLUDED WITH CORE CONFERENCE. REGISTRATION REQUESTED

SPONSORED BREAKFAST TBD // FRI 7:15 AM � COST INCLUDED WITH CORE CONFERENCE. REGISTRATION REQUESTEDEARLY CAREER RECEPTION // WED PM � COST INCLUDED WITH CORE CONFERENCE. REGISTRATION REQUESTEDACRM EXPO // OPEN TO PUBLIC // WED PM � COST INCLUDED WITH CORE CONFERENCE. REGISTRATION REQUESTEDSHELDON BERROL MEMORIAL CHAUTAUQUA � COST INCLUDED WITH CORE CONFERENCE. REGISTRATION REQUESTEDPLENARY SESSION // THU 8:30 AM � COST INCLUDED WITH CORE CONFERENCE. REGISTRATION REQUESTEDEXHIBITORS WELCOME RECEPTION WITH POSTER VIEWING // THU PM � COST INCLUDED WITH CORE CONFERENCE. REGISTRATION REQUESTED

PLENARY SESSION // FRI 11:00 AM � COST INCLUDED WITH CORE CONFERENCE. REGISTRATION REQUESTED

ACRM MEMBERSHIP MEETING // FRI 5:45 PM � COST INCLUDED WITH CORE CONFERENCE. REGISTRATION REQUESTED

COULTER LECTURE // SAT 8:30 AM � COST INCLUDED WITH CORE CONFERENCE. REGISTRATION REQUESTED

7 – 11 OCTOBER 2014PROGRESS IN

REHABILITATION RESEARCHACRM 91st Annual Conference

INTERCONTINENTAL, TORONTO CENTRE AND THE METRO TORONTO CONVENTION CENTRE TORONTO, ON, CANADA

www.ACRM.org T: +1.703.435.5335PG 5

KEY, TERMS & CONDITIONS AND RATE INFO

NON-MEMBER registration includes a 6-month introductory ACRM membership with a subscription to the journal, Archives of Physical Medicine and Rehabilitation.

RESIDENT / STUDENT / FELLOW: Enrolled in an accredited school of medicine or approved graduate or under graduate program or fellowship in a medical rehabilitation discipline. Current ID required at registration check-in.

EARLY CAREER: First five years following post-graduate studies.

TE R M S & CON DITION SCANCELLATION POLICY: All registration cancellations and refund requests must be submitted in writing to sbarrah@ACRM.org. A cancellation fee of $195 USD will be charged on all cancellations received before 31 August 2014. The balance of registration paid will be refunded. After 31 August 2014, a fee of $195 USD or 50 percent of registration paid, whichever is greater, will be charged and any balance refunded. If registration amount paid is less than $195, no refund will be given. No refunds will be made after 21 September 2014. Those who registered as non-members retain their 6-month ACRM membership, including a subscription to the ACRM journal, Archives of Physical Medicine & Rehabilitation. ACRM members who cancel will receive a 6-month extension to their membership.

SUBSTITUTIONS / TRANSFERS: The original registrant will be charged a substitution fee of $195 USD and receive a 6-month ACRM membership.

FORCE MAJEURE In the event of a full or partial cancellation of the ACRM Annual Conference due to natural disaster or other force beyond the control of ACRM, ACRM will make a pro rata distribution of cancellation insurance proceeds applicable to registration refunds.

PHOTO RELEASE POLICY Registration and attendance at or participation in the ACRM Annual Conference, Progress in Rehabilitation Research, constitutes an agreement by the registrant to the use and distribution (both now and in the future) of the registrant or attendee’s image or voice in photographs, videotapes, electronic reproductions and audio files of such events and activities to illustrate and promote the conference experience.

MEDIA / PR RATE: Members of the media and social media writers relevant to rehabilitation research may contact Signy Roberts at sroberts@ACRM.org for information on press entry and a limited number of potential social media/PR ambassador opportunities.

SPECIAL CIRCUMSTANCES / GROUP RATES: Attendees from lesser developed countries (LDC), groups of five or more, and individuals with special financial circumstances, such as unemployment, may email Jenny Richard, ACRM Director Member Services at Jrichard@ACRM.org or phone +1.703.435.5335 to learn about special offers that may apply.

PLEASE CHECK!

� I have read and agree to the Terms & Conditions above

7 – 11 OCTOBER 2014PROGRESS IN

REHABILITATION RESEARCHACRM 91st Annual Conference

INTERCONTINENTAL, TORONTO CENTRE AND THE METRO TORONTO CONVENTION CENTRE TORONTO, ON, CANADA

www.ACRM.org T: +1.703.435.5335PG 6

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:_____________________________________

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$___________TOTAL AMOUNT in USD

PROMO CODE:___________ DISCOUNT CODE:___________

< The sum from your selections on the previous pages.

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

EMAIL: MemberServices@ACRM.org ORFAX: +1.866.692.1619 ORMAIL: PO BOX 759272, Baltimore MD 21275-9272

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For questions related to the status of registrations, please contact MemberServices@ACRM.org or phone: +1.703.574.5845

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7 – 11 OCTOBER 2014PROGRESS IN

REHABILITATION RESEARCHACRM 91st Annual Conference

INTERCONTINENTAL, TORONTO CENTRE AND THE METRO TORONTO CONVENTION CENTRE TORONTO, ON, CANADA