2012 Conference and Exhibition Online Registration Form Payment must be received on or before April 20, 2012 to guarantee a spot. Registration cancellations after April 1, 2012 are non-refundable. Please phone our office at (204) 477-9888 if you have any questions. Please make cheque payable to: Long Term & Continuing Care Association of Manitoba 103-1483 Pembina Highway Winnipeg, Manitoba R3T 2C6 GST # 865356869RT0001 Conference Location Conference Date Registration Deadline Victoria Inn Hotel 1808 Wellington Ave. Winnipeg, MB (204) 786-4801 Tuesday, May 15, 2012 April 20, 2012 Contact Information First Name:* Last Name:* Position: Facility Name: Telephone:* Email: Delegate List LTCAM will be providing a delegate list containing your business card information to exhibitors, as permitted by applicable privacy legislation. If you do not wish your e-mail address to be provided, please check the following: I do not wish my e-mail address to be provided to participating exhibitors. Registration Fee Refer to our website to confirm membership status at www.ltcam.mb.ca/memberlist.html LTCAM Active Member $60.00 + GST = $63.00 LTCAM Associate/Commercial Member $85.00 + GST = $89.25 Non Member $110.00 + GST = $115.50 Student       (You will be required to present your student       card during registration the day of the       conference.) $60.00 + GST = $63.00 Student #: Older Adult (Must be > 65 years) $60.00 + GST = $63.00 Additional Information I will be attending the Continental Breakfast (included) Please provide me with a receipt of payment (provide email address above) I will require a Certificate of Attendance (provide email address above) Food allergies/intolerances: How did you learn about the 2011 Long Term Care Conference? Staff development personnel/department/co-worker/internal newsletter LTCAM Website LTCAM News Releases WAVE Magazine Radio Twitter/Facebook Word of Mouth Attended last year Other: Session Selection 7:00am-8:00am Registration & Breakfast in Exhibitor Hall 8:00am - 8:10am Greetings & Opening Remarks in Plenary Hall 8:10am - 9:10am Session #1 (all attend) Keynote Presentation Mutual Respect: The Key to Excellence in Care Please select one of the following concurrent sessions: 9:15am - 10:00am Session #2 - Do You Want Fries With That? Session #3 - Hearing Care and the Elderly - The Challenges of Aging Session #4 - Engaging Patients/Clients/Residents and their Families in Improvement Work Please select one of the following concurrent sessions: 10:45am - 11:55am Session #5 - Broken Covenant: Health Care Aides' Experience of the Ethical in Caring for Dying Seniors in a PCH Session #6 - The Heart Has No Wrinkles: Creating a Person-Centred Approach to Sexuality and Intimacy in Long Term & Continuing Care Please select one of the following concurrent sessions: 1:30pm - 2:30pm Session #7 - Falls Prevention and the Older Adult Session Session #8 - Collaborative Care: Better Health For All Session #9 - Practical Management of Challenging Behaviours in Dementia Care 3:00pm - 4:15pm Mind and Memory: You say Goodbye, I say Hello Session #10 (all attend) This demographics survey is anonymous and will assist us in planning future conferences. I work in: PCH Supportive Housing Residence Retirement residence Hospital Community Service industry I do not work in health care but have interest in the presented topics Other: Age: Under 18 18 - 25 25 - 35 35 - 45 45 - 55 55+ Gender: Male Female From which area of Manitoba: Rural Winnipeg Outside of province Other: I live and/or work in the following Health Authority: Assiniboine Brandon Burntwood Central Churchill Interlake Norman North Eastman Parkland South Eastman Winnipeg Outside MB I do not know