Family Childcare Conference Registration Form Name(Required) First Last Phone(Required)Email(Required) Please indicate your race American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Please indicate your ethnicity Hispanic or Latino Not Hispanic or Latino Education(Required)Select all that apply High School Diploma or GED CDA Some college, no degree yet Associate degree Bachelor's degree Master's degree Doctorate Program InformationProgram Name(Required)What does your childcare call itself? Your role(Required) Owner/Operator Staff Do you participate in Paths to QUALITY?(Required) Yes No No, but we are accredited Select your current Paths to QUALITY level(Required) Level 1 Level 2 Level 3 Level 4 Please provide your accreditations(Required) Program Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Which county does this program reside in?(Required) Does this program use a childcare management system?(Required) Yes No What is the name of the childcare management system?Examples include, Brightwheel or ProCare Pay for your registrationStandard Registration Fee Price: Which days do you plan to attend?(Required)This information is needed for headcounts, it will not impact your registration fee. Friday Only Saturday Only Friday & Saturday HiddenEarly Bird Discounts(Required)Choose which days you're interested in participating. The following discounts will expire on January 14, 2023 Friday & Saturday Saturday Only How many people are you registering for?(Required)Please enter a number from 1 to 10.Please enter the name(s) of your guest(s) separated by a comma Promo Code Deco County DiscountDeco County DiscountNo DiscountAmount Due Credit Card(Required) Cardholder Name Card Details Address of credit card(Required) Same as program address Street Address Address Line 2 City State ZIP NameThis field is for validation purposes and should be left unchanged.