Racers
Start Your Engines
Conference Brochure
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July 30 – August 2
Sheraton at Keystone Crossing
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If you choose to venture away from the Keystone area there are several
exciting and fun things to do in Indianapolis.
Indianapolis is known as the racing capital of the world mostly because
of its hosting of the Indianapolis 500 mile race. Since 1911 drivers have risk life and limb to
tame the 2.5 mile oval at speeds over 225 mph.
The Indianapolis Motor Speedway is also home to NASCAR’s Brickyard 400
as well as Moto GP events. IMS features
a hall of fame museum on the speedway grounds with several exhibits as well as
a grounds tour that let you share in the storied tradition.
On your visit to Indy you might
consider these other options as well.
The Indianapolis Children’s Museum, the largest in the world, offers
five stories of excitement and education for children. The Indianapolis Zoo, NCAA Hall of Champions,
White River State Park, Indianapolis Cycloplex, Indianapolis Museum of Art,
Eiteljorg Museum, Indianapolis Indians, Indianapolis Colts, Monument Circle and
Circle Centre Mall all offer something for everyone with many opportunities for
enjoyment
.
This year, the 5p- Society Board of
Directors is instituting a fundraising incentive program for those individuals
that raise money for the Indy conference.
The program, Race for Rewards, will work like this:
Race to
Rewards
Raise
$1500.00 – Registration fee for up to 2 adults and 2 children will be waived
($150.00 value)
Raise
$3000.00 – Registration fee for up to 2 adults and 2 children will be waived
($150.00) AND one night at the hotel will be free ($114++)
Raise
$5000.00 – Registration fee for up to 2 adults and 2 children will be waived
($150.00) AND three nights at the hotel will be free ($342.00++)
To be eligible for the Race to
Rewards program you must be a member of the 5p- Society and be in good standing
(membership dues paid). All monies
raised must be received by May 31st. You
may use the Race to Rewards form to make your donation(s) online, or send in
your donations to the 5p- Society office (PO Box 268, Lakewood, CA 90714) with clear instructions as to who the
donations are for and that they are for the Race to Rewards program.
For those of you who raise enough
funds to have one or all of your hotel rooms covered, you will be responsible
for making your own hotel reservations and the 5p- Society and the Sheraton at
Keystone Crossing will make an internal change.
On your
Marks
Venue The 2015 Annual conference will be held at
the Sheraton at Keystone Crossing, located 8787 Keystone Crossing,
Indianapolis, IN 46240 adjacent to the Fashion Mall at Keystone. The 5p- Society has been able to secure a
$114.00 per night room rate for you. You
can make your hotel reservations two ways:
1) Call the hotel directly at (317)846-2700 and tell them you are with
the 5p- Society, or 2) online at https://www.starwoodmeeting.com/events/start.action?id=1407315785&key=2E782DE. The room rates will be honored 3 nights
before and 3 nights after the event. If
you are having difficulty making your reservations, please contact the 5p-
Society office at (888)970-0777.
Transportation The hotel is located off of I-465 at Exit 33 and is located right behind
the mall on the right. The Sheraton
website has great driving directions from any direction at http://www.starwoodhotels.com/sheraton/property/area/directions.html?propertyID=158.
If you are not driving but flying into Indianapolis International
Airport, your options to get to the hotel are a Taxi service (approx.. $65.00)
or Above and Beyond Limousine. Above and
Beyond Limousine can be reserved by calling (317)257-0739 or visit their
website at www.a-blimo.com (reservations required) and the fees are based on
the number of passengers (reservations must be made 24 hours in advance). If you choose to rent a vehicle, please
remember that the 5p- Society has a corporate number through Avis. The AWD Number is Z829971.
Family Outing 5p- Society is happy to announce that the host families have secured the
Indianapolis Zoo as the Family Fun Event.
At the Indianapolis Zoo, you can have three times the fun as this Zoo
was the first institution to become triple accredited as a Zoo, botanical
garden and aquarium. The cost to attend the event is $8.00 per person. Children or adults with Cri du Chat Syndrome
will be admitted at no cost. Zoo
personnel would like a final count 2 days prior to the event, therefore
Pre-registration is required. Please
indicate on your registration if you will be attending the event. Transportation and lunch will be provided.
Sibling Outing The sibling outing will be at Caribbean Cove Water Park. The siblings of individuals with Cri du Chat
Syndrome (ages 6 and up), who attend the 2015 5p- Society conference, are
invited to attend the sibling outing.
Thanks to the host families and fundraising events that have been
dedicated to the sibling outing, there will be no direct cost to the
families. Please make sure you sign your
sibling(s) up with the conference registration form and return the information
into the 5p- Society no later than Friday, July 24 to guarantee that your
child(ren) will be able to attend. Space
will be limited to those who sign up after the 24th of July. There will be plenty of adult supervision!!
(or if you would like to volunteer to supervise, please let the 5p- Society office
know)
Child Care Complimentary child care is available for children and adults with Cri du
Chat Syndrome (all ages) and their siblings (ages 0-13). Child care providers are family members and
friends of our host families along with community volunteers. There will be
five child care rooms divided by age. If
you have a caregiver coming with you that would like to volunteer to assist in
the child care room, please let us know.
Family
Assistance Program The
5p– Society is happy to announce that there will be five (5) scholarships available
for families who would like to attend the conference but could use a little financial
assistance. The scholarship will assist with the hotel fee for three nights and
the basic registration fee for up to two adults and two children. For more info
and an application please send an email to director@fivepminus.org or download
a form at www.5pminus2015conference.blogspot.com or at
www.fivepminus.org/Next_Conference. Thank you to the Turner Family and Moore Family
for their assistance with the Scholarship program. Application due date is May
1st.
Hall of Fame Nominations The 5p– Society
is now accepting nominations for the 5p– Society Hall of Fame. Categories are:
Parent of the Year, Grandparent of the Year, Sibling of the Year and a our open
category Checkered Flag Winner of the year. The open category can be a
caregiver, volunteer, other family member, doctor, therapist who has gone above
and beyond in support of the 5p– Society. Application due date is June 25th.
Form can be found in this brochure or download a form at www.5pminus2015conference.blogspot.com or at www.fivepminus.org/Next_Conference .
Claudia Sanger Lending Library In memory of one of our most dynamic parents, Claudia
Sanger, who lost her life to breast cancer, the 5p- Society asks those of you
who are attending the conference to bring an item or idea with you to share or
lend out to another family. Some ideas
have been AFO’s, toys, or clothes.
What Works Table The 5p- Society also has a table set aside for you to
share your ideas with the other families as to what has worked for you with
your child. This can be a product, an
idea, or a system. Your participation is
welcomed.
Raffles and 5P Gear To help supplement the conference expenses, the
grandparents and other members of the 5p- Society participate by donating items
to raffle off. Handmade quilts, handmade
jewelry boxes, jewelry, gift baskets and other items will be available. If you have something you’d like to bring to
raffle off, please let us know.
Meet the
speakers
(Proposed, subject to change)
Ambucs
National
AMBUCS™, Inc. is a non-profit service organization who are dedicated to
creating
mobility and independence for people with disabilities, including providing
AmTryke® therapeutic tricycles to
individuals unable to operate a traditional bike.
Erin Buck Kriel, Developmental
Optometrist
Vision and
Learning
Greenwood Vision Development Center, Greenwood, Indiana
Dennis Campbell, Ph.D. and
Parent
Cri du Chat
101
Positive
Effective Behavior Modification
University
of South Alabama, Mobile, Alabama
Wendy J. Gahimer, M.A., CCC/SLP
Augmentative Communication
Easter
Seals Crossroads, Indianapolis, Indiana
Jennifer Grillo, PTA &
Teresa Keathley, PT
Hippotherapy:
A Treatment Strategy for Physical, Occupational and Speech Therapy
The
Children’s Therapy Foundation, Inc.
Nancy Washburn & Crista McIntosh
Transition options after High School
Easter Seals Crossroads, Inc.
Shanida Mathieu, Parent
Navigating the IEP Process – 2 tracks
Louisiana Parent Advocacy, New
Orleans, Louisiana
Gretchen Meyers, MD, and John Mantovani, MD
Neurological
issues with Cri du Chat Syndrome and Autism considerations.
Kent Nicholls, Founder 5p- Society
and Parent
New Family Orientation
Mary Anne Elhert
Protected Tomorrows
Protected Tomorrows
Your Journey through an Eight Step Future Care Planning Program
AmySue Reilly, Ph.D.
Positive Effective Behavior Modification
Auburn University, Auburn,
Alabama
Karrie Veteto, OT
Sensory Processing
Crystal’s Behavior Solutions,
Fishers, Indiana
Schedule of
Events
(Proposed, subject to change)
Thursday July 30 2015
·
5:00 PM – 10:00
PM – Registration
·
5:00 PM – 7:00 PM
– Welcome Reception
·
7:00 PM – 9:00 PM
– New Family Orientation
·
7:00 PM – 9:00
PM- Sibling Mixer
·
7:00 PM – 11:00
PM – AmySue’s Place*
Friday July 31 2015
·
7:30
AM – 12:15 PM – Child Care
·
8:30
AM – 9:00 AM – Opening Session
·
9:00
AM – 10:30 AM – Parent Panels
·
9:00
AM – 12:00 PM – Sibling Supportshop
·
10:30
AM – 12:00 PM – Breakout sessions
·
12:30
PM – 4:00 PM – Indianapolis Zoo Family Outing
·
4:00
PM – 6:00 PM – Grandparents Supportshop
·
7:00
PM – 11:00 PM- AmySue’s Place*
·
8:00
PM – 11:00 PM - Board of Directors Meeting
Saturday August 1 2015
·
7:30
AM – 5:00 PM – Child Care (break from 12:00 PM-2:00 PM)
·
8:30
AM – 9:00 AM – Keynote Speaker
·
9:00
AM – 12:00 PM – Breakout sessions
9:00
AM – 3:00 PM – Sibling Outing Caribbean Cove
·
12:00
PM – 2:00 PM – Lunch on your own
·
2:00
PM – 5:00 PM – Breakout sessions
·
6:00
PM – 10:00 PM - Banquet, Dance, Pictures
·
9:00
PM – 11:00 PM –AmySue’s Place*
Sunday August 2 2015
·
10:00
AM – 12:00 PM – Closing session
*AmySue’s Place aka
Hospitality Suite
Team
Indy
Many thanks to the
Indianapolis Conference Committee for the many hours planning, raising
money, and preparing for the conference to make it a success for the
families!!
Jason
& Michelle Myatt
Brad
& Kyla Chandler
Foster
& Stephanie Pilcher
Board
of Directors
|
Banquet and Family Dance
The attire for the Family Banquet is casual.
Volunteer Opportunities
Volunteers are needed for child care throughout the
conference. If you have some extra
family members or know of anyone local to the event who can give a couple of
hours, please contact the 5p- Society office at (888)970-0777 or send Laura an
email at director@fivepminus.org.
T-Shirts
T-shirt for the event can be ordered with your registration
form or can be ordered separately. To
guarantee your sizes all shirt orders must be received by July 1st. A limited amount of sizes will be available
at the conference. Not attending the
conference but would like t-shirts?
Please contact Laura at director@fivepminus.org
for an order form.
Conference Registration Form |
Thank you for registering for the 2015 5p- Society Annual
Conference. We want to make the process
as easy as possible. This is a family
registration form. Please not that a
child is considered under 17 and will receive a child’s meal at the
banquet. If you would like your “child”
who is under 17 to receive an adult meal, please indicate under “meal
selection.” Your registration fee will
increase by $25.00. We recognize that
some adults with Cri du Chat Syndrome may need a soft meal and the children’s
meal would be a better choice for them.
If this is the case, please indicate under “meal selection.”
Please fill out the form completely for each person who is
attending, including your child with Cri du Chat Syndrome. If you require additional space, please send
an email to director@fivepminus.org.
T-shirts may be ordered with your registration form. To guarantee your t-shirt order is
received, please return this form no later than July 1, 2015.
If you have any questions about this registration form,
please call 888-970-0777.
FAMILY REGISTRATION
Family registration is for up to 2 adults and 2 children
(under 17)
Please indicate your membership type (X)
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Member ($150):
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Non-Member ($200):
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Name:
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Phone No:
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Address:
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Email:
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City:
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Province/State:
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Zip Code:
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Country:
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Tell us about who are coming
Name
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Relationship to Individual with Cri du
Chat Syndrome
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Dietary Needs
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T-shirt Size
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Adult 1
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Adult 2
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Child 1
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Child 2
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For Child 1 and 2 please fill out the following:
Child’s Age
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Child Care?
Y or N
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Sibling Outing
(siblings only)
Y or N
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Meal Selection – Child or Adult
(additional $25 for adult meal)
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Child 1
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Child 2
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Additional Adults - $50.00
Name
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Relationship to Individual with Cri du
Chat Syndrome
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Dietary Needs
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T-shirt Size
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Adult 3
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Adult 4
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Adult 5
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Adult 6
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Additional Children - $25.00
Name
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Relationship to Individual with Cri du
Chat Syndrome
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Dietary Needs
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T-shirt Size
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Child 3
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Child 4
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Child 5
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Child 6
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For Child 3, 4, 5 & 6 please fill out the following:
Child’s Age
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Child Care?
Y or N
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Sibling Outing
(siblings only)
Y or N
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Meal Selection – Child or Adult (additional
$25 for adult meal)
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Child 3
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Child 4
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Child 5
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Child 6
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The Family Fun Event will be held at the Indianapolis
Zoo. Children and adults with Cri du
Chat Syndrome will be free to enter the Zoo.
There will be an $8.00 group rate fee for all others. Please indicate below how many tickets you
would like to purchase.
# of Tickets x $8.00 ________________
T-Shirts are $10.00 each.
Please indicate how many T-Shirts you have ordered:
# of T-Shirts x $10.00 ______________
Photo Release:
I/we acknowledge that I may be photographed, or
recorded. I hereby release to the 5p-
Society all proprietary rights and copyrights in all such photographs, digital
images, voices, recordings, actions, films and likenesses (including negatives,
positives and prints) which shall be and remain the property of the 5p-
Society. I understand that this material
may be used in various publications, public affairs releases, recruitment
material, and broadcasts or for other related endeavors. This material may also appear on the
5p-
Society’s website, and other public social media sites.
I expressly release the 5p- Society, its directors,
officers, employees, agents and volunteers, from any and all claims, including
copyright and privacy, arising out of any reproduction, broadcast,
distribution, publication, or promotion of this event.
_________________________________ ___________________________________
Signature Signature
For planning
purposes, please indicate your child’s deletion type: “de novo”, unbalanced translocation, mosaic,
unknown or other: __________________________________________
Information to help us plan a little
better
·
Will you be driving or flying?
_____________________
·
Are you staying at the Sheraton at Keystone
Crossing or off site? _____________________
·
Did you order a crib from the hotel? _________
·
Did you order a refrigerator from the hotel?
__________
·
Do you need a high chair? ____________
You may also
renew your membership with the 5p- Society along with your registration. If you are not a member, you can pay the
annual $25.00 membership fee now and pay the Member Registration of $150.00
(this saves you $25.00). We may also pay
three years of your membership fee and save $5.00 by paying $70.00.
Let’s add it
all up!
Registration Fee
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Member
Non-Member
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$150.00
$200.00
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Additional Adults
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#
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$50.00 each
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Additional Children
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#
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$25.00 each
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Add Additional Adult
Meal for Child
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#
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$25.00 each
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Indianapolis Zoo
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#
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$8.00 each
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T-Shirts
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#
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$10.00 each
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Membership Dues
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1 Year
3 Years
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$25.00
$70.00
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Total
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Please make
a check or money order (US Dollars):
5p- Society
PO Box 268
Lakewood,
CA 90714
If you would
like to pay with credit card:
Name on
Card: __________________________________________
Card Number:
___________________________________________ Expiration Date: ______________
3 or 4 Digit
Security Code: ___________
Signature:
_________________________________________
Mail to
address above, or fax to 562-920-5240 (secure)
Please
return all 4 pages of your registration form.
Thank you!!!
Hall of Fame Honoree
Submission Form
Parent of the Year, Sibling of the Year, Grandparent of the Year
or Volunteer of the Year
To
honor that special parent, sibling, or grandparent, or volunteer who has gone
above and beyond, for the 5p- Society, please fill out the below form and
submit. Please be sure to include all of the information, especially the
honoree's mailing address and phone number (we need that information in order
to contact your honoree). Also, be sure to tell us how this person went above
and beyond for the 5p- Society. We look forward to hearing from you! Awards will be presented, during the banquet, on August
1, 2015 at the 5p- Society's National Conference, in Indianapolis, Indiana.
Deadline for submission
is: June 25, 2015.
Please submit forms
via email or mail to:
5p- Society Nomination
for:
Attn: Hall Of Fame Nominations
PO Box 268 ___
Parent of the Year
Lakewood, CA 90714 ___
Sibling of the Year
director@fivepminus.org ___
Grandparent of the Year
___
Volunteer of the Year
Full Name of Nominee: Nominator’s
Full Name:
__________________________ __________________________
Nominee’s Email Address: Nominator’s
Email Address:
__________________________ __________________________
Nominee’s Phone Number: Nominator’s
Phone Number:
__________________________ __________________________
Nominee’s Street Address: Nominator’s
Street Address:
__________________________ __________________________
Nominee’s City / State / Zip: Nominator’s
City / State / Zip:
__________________________ __________________________
On a separate piece of paper, please tell us why you feel
your nominee should receive the award.
TShirt
Order Form
Please use
this T-shirt order form ONLY if you are not attending the conference, but would
like T-shirts. If you are attending the
conference please put your order on the registration form on pages 5-8. T-Shirts are $10 each. Shipping is $5.00 for every 3 shirts
ordered. ORDERS MUST BE RECEIVED BY JULY 1, 2015. Thank you.
Design Front and Design Back
Please
indicate your sizes and quantities. Add
it up, add in shipping and submit your order form. This is a mail in or fax in form. If you would like to order T-shirts online,
please go to
Name
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Address
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City
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State/Province
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||||||
Zip
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Phone #
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Email
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Please make check payable to 5p- Society and send
to:
5p- Society
PO Box 268
Lakewood, CA
90714
Or if paying with credit card, indicate below and mail
to above address or fax to (562)920-5240.
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Youth Sizes
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Quantities
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Adult Sizes
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Quantities
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Youth Small 2-4
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Adult Small
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Youth Medium 6-8
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Adult Medium
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Youth Large 10-12
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Adult Large
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Youth X-Large 14-16
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Adult X-Large
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Adult XX-Large
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Adult XXX-Large
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Totals
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Totals
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Please add $5.00 shipping for every 3
shirts ordered.
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Total Number of shirts x $10.00 = + shipping = Total of
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Type of Card Accepted: Visa, Mastercard or American Express
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Card No.
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Expiration Date
(xx/xx)
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3 digit or 4 digit Security code
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Amount of Transaction
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Name on Card
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Signature
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