Membership Please select the membership shown below. Then click on "Continue" to confirm your order selections and total. After that we will ask for your name and address information and your payment information to complete your order on our secure server.   New -Agency Member - 1 year Agency membership will include the following benefits: an identified agency contact will receive one copy of JPBI (including the APBS Newsletter) on a quartly basis, the agency contact will have one (1) vote on APBS voting matters, including elections, and The Agency will be able to register up to a maximum of three (3) agency staff to attend the annual conference at the membership rate for that given year, given that they meet all relevant deadlines established for registration.      Order at $125.00 each     Renew -Agency Member - 1 year Agency membership will include the following benefits: an identified agency contact will receive one copy of JPBI (including the APBS Newsletter) on a quartly basis, the agency contact will have one (1) vote on APBS voting matters, including elections, and The Agency will be able to register up to a maximum of three (3) agency staff to attend the annual conference at the membership rate for that given year, given that they meet all relevant deadlines established for registration.      Order at $125.00 each     New -Family Member - 1 year Family Membership will be given to individuals who verify that they are providing direct care or support to an immediate family member, i.e., child, adolescent or adult, who demonstrates chronic or persistent challenging behavior.  Applicant must complete verification on their Membership Form. Member Benefits Opportunities to vote on business matters and elect members of the board Subscription to The Journal of Positive Interventions Subscription to the quarterly APBS Newsletter Discounted registration for APBS conferences Please contact Crystal Andrezze at (570) 389-4074 to verify eligiblity.   Order at $35.00 each     Renew -Family Member - 1 year Family Membership will be given to individuals who verify that they are providing direct care or support to an immediate family member, i.e., child, adolescent or adult, who demonstrates chronic or persistent challenging behavior.  Applicant must complete verification on their Membership Form. Member Benefits Opportunities to vote on business matters and elect members of the board Subscription to The Journal of Positive Interventions Subscription to the quarterly APBS Newsletter Discounted registration for APBS conferences Please contact Crystal Andrezze at (570) 389-4074 to verify eligiblity.   Order at $35.00 each     New -Family Member - 3 years Family Membership will be given to individuals who verify that they are providing direct care or support to an immediate family member, i.e., child, adolescent or adult, who demonstrates chronic or persistent challenging behavior.  Applicant must complete verification on their Membership Form. Member Benefits Opportunities to vote on business matters and elect members of the board Subscription to The Journal of Positive Interventions Subscription to the quarterly APBS Newsletter Discounted registration for APBS conferences Please contact Crystal Andrezze at (570) 389-4074 to verify eligiblity.   Order at $100.00 each     Renew -Family Member - 3 years Family Membership will be given to individuals who verify that they are providing direct care or support to an immediate family member, i.e., child, adolescent or adult, who demonstrates chronic or persistent challenging behavior.  Applicant must complete verification on their Membership Form. Member Benefits Opportunities to vote on business matters and elect members of the board Subscription to The Journal of Positive Interventions Subscription to the quarterly APBS Newsletter Discounted registration for APBS conferences Please contact Crystal Andrezze at (570) 389-4074 to verify eligiblity.   Order at $100.00 each     New -Regular Member - 1 year Member Benefits Opportunities to vote on business matters and elect members of the board Subscription to The Journal of Positive Interventions Subscription to the quarterly APBS Newsletter Discounted registration for APBS conferences   Order at $80.00 each     Renew -Regular Member - 1 year Member Benefits Opportunities to vote on business matters and elect members of the board Subscription to The Journal of Positive Interventions Subscription to the quarterly APBS Newsletter Discounted registration for APBS conferences   Order at $80.00 each     New -Regular Member - 3 years Member Benefits Opportunities to vote on business matters and elect members of the board Subscription to The Journal of Positive Interventions Subscription to the quarterly APBS Newsletter Discounted registration for APBS conferences   Order at $200.00 each     Renew -Regular Member - 3 years Member Benefits Opportunities to vote on business matters and elect members of the board Subscription to The Journal of Positive Interventions Subscription to the quarterly APBS Newsletter Discounted registration for APBS conferences   Order at $200.00 each     New -Student Member - 1 year Student members are full-time undergraduate or graduate students, residents, or interns.  Students must contact Crystal Andrezze to complete verification of full-time student, intern, or resident status.  Member Benefits Opportunities to vote on business matters and elect members of the board Subscription to The Journal of Positive Interventions Subscription to the quarterly APBS Newsletter Discounted registration for APBS conferences Please contact Crystal Andrezze at (570) 389-4074 to verify eligiblity.   Order at $35.00 each     Renew -Student Member - 1 year Student members are full-time undergraduate or graduate students, residents, or interns.  Students must contact Crystal Andrezze to complete verification of full-time student, intern, or resident status.  Member Benefits Opportunities to vote on business matters and elect members of the board Subscription to The Journal of Positive Interventions Subscription to the quarterly APBS Newsletter Discounted registration for APBS conferences Please contact Crystal Andrezze at (570) 389-4074 to verify eligiblity.   Order at $35.00 each

Activity Questionnaire The Association for Positive Behavior Support has requested that its customers provide the following information to better help it fulfill your order. Required questions must be answered in order to complete your order.    I want to receive email information of APBS activities, network petitions or other related events. **Required YesNo  If you would like your contact information posted for networking purposes in the Member's Section of the APBS website, please list it below. You may include up to 5 website URLs        Please check one box that most closely describes your job title: **Required PractitionerAdministratorStudentConsultant/TrainerAcademic/ProfessorAcademic/StudentPsychologistAdult Service ProviderEarly Childhood ProfessionalResearcherSocial WorkerCounselorBehavior SpecialistSchool TeacherParent or Family MemberSchool-wide PBS Team MemberOther  Check the one box that most closely represents your stakeholder group or the area in which you are affiliated: **Required Adult Residential SupportsAutismTertiary Level Supports - CommunityTertiary Level Supports - Educational SettingsEarly ChildhoodChild WelfareMental HealthJuvenile JusticeTraumatic Brain InjurySchool-wide Positive Behavior SupportEmotional and Behavioral DisordersPhysiological and Biological Issues Related to BehaviorFamily SupportsStatewide PlanningFamily SupportsPolicy Development and Statewide Planning  Please indicate if you would be willing to volunteer on any of the current APBS subgroups   Website SubgroupMembership SubgroupNominations SubgroupFamily SubgroupNetwork Subgroup Hold down the "Ctrl" key to select multiple responses.  Educational Backgroup Information (please select highest attained)   High SchoolUndergraduateMaster'sDoctoralPost Doctoral  Students - Please provide the following information: Name of University, Program Name and Expected Graduation Daye        Professionals - Please provide the following information: Most recent degree earned, Conferring Institution and Year received.        Annual Income Range   <$15,000$15,000-$35,000$35,000-$55,000$55,000-$75,000$75,000-$100,000$100,000-$150,000>$150,000I do not wish to share to date  Reason for Membership or Renewal   Implementing PBS in the FieldAttending University Program/SchoolMember of Family Implementing PBSGeneral Interest in PBSRequirement of Current EmploymentOther  If you are a member of another organization, please list it below:        Would you be interested in seeking BCBA credits or CEU's?   YesNo  Please list the languages you speak starting with your primary language and continuing in descending order.

The Association for Positive Behavior Support Purchase/refund policy: CANCELLATION AND REFUND POLICY FOR APBS MEMBERSHIP: There are no refunds or cancellations of APBS membership dues. CANCELLATION AND REFUND POLICY FOR APBS 2011 CONFERENCE REGISTRATION: A US $35 service charge will be assessed for processing refunds. For cancellation and appropriate refund, please state in writing your cancellation and request for refund including the registrant's name and amount of payment (email is acceptable). All cancellations must be received (not postmarked) in the APBS office by 5:00 pm on February 23, 2011. “No Shows” will be billed the full registration fee. We regret that we cannot offer refunds for “No Shows;” however, participants may send a substitute participant in their place without penalty. NO REQUESTS FOR REFUNDS WILL BE CONSIDERED AFTER February 23, 2011. Acteva's Purchase/refund policy: Refunds and cancellations are provided only at the discretion of the organization hosting or sponsoring this event. Acteva issues credits only when directed to do so by the sponsoring organization. Contact refunds@acteva.com or the sponsoring organization for further details.