To register, complete the on-line registration form below and provide interaccount information or mail a check, payable to the Kentucky State Treasurer, to: Prescription for Change, PO Box 4817, Frankfort, Kentucky 40604.  Alternatively, you can print a PDF version of the registration form, copy as many times as needed, and mail the registration form to Prescription for Change at the PO Box listed above with a check or money order made payable to the Kentucky State Treasurer, or fax it to 502-564-1412 or 800-383-1412, along with your interaccount information.

The registration fee is $60 or you may also register at the door.

We also offer a special Student Rate of $10, a Group Rate of 1 registration free with 4 paid registrations, and scholarships.

The Center's offices will be closed on Friday, November 11, 2005, in honor of Veterans Day, and staff will be in Louisville on Monday preparing for the conference.  All faxed registrations received by noon on Thursday, November 10, 2005.

Any registrations after noon Thursday, November 10, 2005, MUST BE MADE AT THE DOOR.

You will need Adobe Acrobat Reader installed to be able to view and print the registration form in PDF. If you do not have a copy of Adobe Acrobat Reader, click on the icon below.

If you prefer you may print out the registration form and fax to 502/564-1412 or outside Frankfort 800/383-1412.

Otherwise, please complete the following online form.

Please read our cancellation, refund and substitution policies.

Personal Information for Registration (* denotes required fields) *Title (Mr./Ms./Dr./Sen./Rep./Rev., etc.) *First Name: *Last Name:  Organization: *Address: *City: *State/Province: *ZIP Code: - *Telephone: / Fax: / *E-mail: Conference Registration (choose one) Group Rates (register 4 and the 5th attends free) and a limited number of scholarships are available. Fees below include registration for all sessions, continental breakfast, lunch, and refreshments. Registration after November 7, 2005 — $60 Student Registration  — $10 Group Rate 5th attendee  — Free      To confirm eligibility, please provide names of the four paid registrations:   *Payment Method (You MUST indicate a payment method to complete registration!) Check #    (Note:  Please mail check to the address below.) MARS Agency # (State Government only) Contact person who handles interaccounts (State Government Only): Name: Telephone Number: Email Address: Please describe any special needs (Dietary or Other): the form

Cancellation, Refund and Substitution Policies
Refunds will be made for all cancellations received in writing by November 7, 2005.  No refunds will be made after that date. Substitutions may be made at any time without penalty.  "No shows" will be charged the full registration price.