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The Brain Injury Association of Indiana is a nonprofit 501 c (3) service organization dedicated to reducing the incidence and impact of brain injury through education, advocacy, support, prevention and by facilitating inter-agency commitment and collaboration.

The Brain and Beyond:

Research, Interventions, Services, and Coordination

Valle Vista Golf Club and Conference Center

755 East Main Street - Greenwood, IN

2010 FALL EDUCATION CONFERENCE

2010 FALL EDUCATION CONFERENCE

2010 FALL EDUCATION CONFERENCE

OCTOBER 13

OCTOBER 13

OCTOBER 13

-

-

-

15, 2010

15, 2010

15, 2010

KEYNOTE SPEAKERS:

Dr. Flora Hammond

Professor and Chair of the Department of Physical Medicine and Rehabilitation

at Indiana University School of Medicine

&

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Here to date, 2010 has been a very good year for the Brain Injury Association

of Indiana. Some of our accomplishments include:

Re-organization of the Board of Directors to engage more diverse

segments and interests from throughout the State;

Retained Central Office Management Solutions to provide association

management services as well as the services of an Executive Director;

Updated and revised our bylaws to more accurately reflect the current

structure of BIAI and to promote transparency to the public concerning

the authority, roles and participation of interested constituencies; and

Development of new or re-structured Committees including Education,

Prevention, Membership, Fundraising, and Support Groups.

The first priority of the year has been to enhance resources and training for the BIAI Support

Groups because they are the foundation of our Association’s history and the backbone of our future.

In order to better capture attendees of Support Groups and our true membership, survivors and their

families’ memberships are now free of charge. The BIAI Fund Development Committee has

embarked on a campaign to raise $50,000 to provide each of the now 19 Support Groups a Support

Group Toolbox, a laptop computer and training. Our first Support Group Leader Training Meeting

in May was very well attended and we hope to engage each Support Group in this initiative. We have

also developed a variety of new advertising and sponsorship benefits for “

Friends of BIAI”

that offer

value to different supporters around the state. We have also begun joint meetings between the BIAI

and the 2009-2013 HRSA Brain Injury Grant to promote the development of BIAI as part of the

sustainability plan for this Grant.

The 2010 Fall Conference is unique and exciting in several respects. Most of the presenters

are entirely new to the Indiana BIAI thanks to sterling leadership provided by Christa Peters and Dr.

David Salisbury. The conference will be preceded by a golf outing and dinner at the Valle Vista Golf

Club. We have reduced our fees for the Conference to promote access in difficult economic times.

There will also be a session at the Conference Chaired by Senator Pat Miller where we will also begin

a new initiative with our “Brain Injury Community Multi-Agency Partnership.” In this session, we

will attempt to build awareness for both rehabilitation providers and state agency representatives about

the respective needs and opportunities in Indiana for brain injury rehabilitation. This will be

accom-plished through a review of the rehabilitation plan and program, as well as their funding strategies,

for two people with brain injury.

Lastly, there will be a special session where the Boards of Directors of BIAI, the Indiana

Spinal Cord and Brain Injury Research Fund, and the Leadership Board of the 2009-2013 HRSA

Grant and conference participants will be able to engage in a structured and facilitated discussion

about new developments in Indiana regarding brain injury to build synergies, new ideas and awareness.

We hope that you will be able to participate in the momentum that is evolving in Indiana

regarding brain injury as reflected in our Conference. We look forward to seeing old as well as new

faces, and, by the way, don’t forget the golf outing!!!

Dr. Lance Trexler

BIAI Chairperson

WELCOME MESSAGE

WELCOME MESSAGE

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Conference Objectives

1. Attendees will acquire knowledge of research and interventions related to brain injury.

2. Attendees will acquire action strategies for identifying and acquiring appropriate services for consumers of brain injury services.

3. Attendees will have the opportunity to participate in interactive and participatory sessions that will be facilitated to promote coordination of services and integration of strategies derived from

presentations.

4. Specialized training and examination will be provided for the Certification of Brain Injury Specialist (CBIS) program in a joint partnership with the American Academy of Certified Brain Injury

Specialists (AACBIS).

Location and Hotel Accommodations

The Golf Outing and Educational Conference will take place at Valle Vista Golf Club and Conference Center - 755 East Main Street ~ Greenwood, IN 46143. (Located off of I-65 just south of Indianapolis.)

The Brain Injury Association of Indiana has reserved a room block at the Hilton Garden Inn Indianapolis

South/Greenwood. The overnight room rate is $109.00 per night (plus tax). For reservations, please call the Hilton

Garden Inn, Indianapolis South/Greenwood directly at 317-888-4814 and indicate you are with the Brain Injury Association of Indiana (BIAI) and ask for the group rate. PLEASE NOTE! The deadline to reserve a room at the conference rate is September 30th.

Exhibitor Space

The Brain Injury Association of Indiana will be offering exhibit booths at the conference. For more information regarding exhibiting, please call the BIAI Central Office at 317-356-7722.

AACBIS Training

Please see page 9 of this brochure for details.

Continuing Education Hours

(CEU’s)

CEUs will be provided for the following professions: Case Management (CMM), Psychology, Social Work,

Mar-riage and Family Therapist, and Mental Health Counselor, Speech Language Pathology, and Occupational

Ther-apy. If applying for CEUs, please indicate accordingly when registering. Certificates of Attendance will be

avail-able onsite.

Handouts

BIAI has moved to electronic handouts. Conference attendees may download the handouts online before and

after the conference. A confirmation postcard with the password for downloading the handouts will be mailed

to each registrant prior to the conference. If you have any questions regarding the electronic format, please

contact BIAI Central Office at 317-356-7722.

GENERAL INFORMATION

GENERAL INFORMATION

GENERAL INFORMATION

Poster Presentations

This year we are pleased to announce our fourth annual poster presentation exhibition. Topics related to serving

persons with brain injury will be presented ranging from the current state of research to what’s happening in

support groups. Unique clinical activities and community opportunities may also be represented. The format

allows for informal viewing during breaks and offers opportunities to talk with representatives of the various

topics.

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50/50 Raffle

Tickets will be sold for $1.00 throughout the conference. The winner will take home half of the total amount raised! The other half will be donated to the Brain Injury Association of Indiana.

Silent Auction

The Brain Injury Association of Indiana will be holding a Silent Auction at the conference. Opening bids will start Thursday morning at 8:30 am and bids will close on Friday at 11:00 am. Please check with the registration desk for a list of the auction winners. Payment for auction items should be made at the conference prior to collecting your items. Credit cards, checks and cash accepted!

ADA Needs

Please specify any ADA needs you may have in attending this conference. If you require special accommodations, please provide a written request along with a completed registration form and conference payment at least 30 days prior to the registration deadline for the conference. We will do our best to accommodate any special needs

.

Cancellation Policy

Cancellation Policy: Written cancellation postmarked two weeks prior to the seminar will be refunded, less a $50 administrative fee. NO REFUNDS will be given for any cancellation after that date, but upon request, we will send you the materials distributed at the seminar.

Mail to: BIAI Central Office, C/O Fall Conference Refund, PO Box 24167, Indianapolis, IN 46224

GENERAL INFORMATION (Continued)

GENERAL INFORMATION (Continued)

GENERAL INFORMATION (Continued)

Other Notes

Disclaimer: The Brain Injury Association of Indiana does not support, endorse or recommend any method,

treat-ment or program for persons with brain injury. We endeavor to inform and believe that you have the right to know what information is available.

For your comfort, we suggest you bring a sweater or layer your clothing. It is difficult for conference facilities to regulate meeting room temperatures, and comfort levels among attendees can vary greatly.

Please do not video-tape or audio-tape any of the sessions unless you have made previous arrangements through the BIAI. Thank you for your cooperation!

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Dr. Flora Hammond is Professor and Chair of the Department of Physical

Medicine and Rehabilitation at Indiana University School of Medicine and Chief

of Medical Affairs at the Rehabilitation Hospital of Indiana.

From 1995-2009, she worked at Carolinas Rehabilitation in Charlotte, North

Carolina where she served as the Brain Injury Program Director and Research

Director. Dr. Hammond graduated from medical school at Tulane University

School of Medicine and completed her residency in Physical Medicine and

Rehabilitation at the Baylor College of Medicine. She completed a brain injury

fellowship at the Rehabilitation Institute of Michigan. Her research in the area

of brain injury includes studying the prediction of outcome, aging with brain injury, causes of and

treatments for irritability, and quality of relationships. Since 1998 she has been serving as the

Principal Investigator and Director of the Carolinas Traumatic Brain Injury Model System grant

funded by the National Institute on Disability Rehabilitation and Research. She also serves as

principal investigator of several other Federally funded research grants including a multicenter

study from the National Institute on Disability and Rehabilitation Research to study the use of

Amantadine to treat irritability and aggression in individuals with chronic brain injury.

Jeffrey E. Mittman

Master Sergeant

United States Army

Jeff Mittman is an American Veteran. Severely injured by an Improvised

Explosive Device (IED), his injuries were so severe that his survival was

questionable. He has spent the last four years recovering both physically and emotionally. Now,

this 40-year-old decorated warrior, husband of 16 years, father of two, and outspoken military

vet-eran will share his hope for the future - both for himself and for other injured vetvet-erans around the

country. His story of his recovery provides insights into the critical impact service providers have

on the rehabilitation of severely injured individuals re-entering the workforce today.

KEYNOTE SPEAKERS

KEYNOTE SPEAKERS

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SCHEDULE

SCHEDULE

SCHEDULE -

-

-

Thursday, October 14th

Thursday, October 14th

Thursday, October 14th

8:00 - 8:30 am

REGISTRATION & BREAKFAST WITH EXHIBITORSREGISTRATION & BREAKFAST WITH EXHIBITORSREGISTRATION & BREAKFAST WITH EXHIBITORS

8:30 - 9:00 am

WELCOME/BIAI Update WELCOME/BIAI Update

WELCOME/BIAI Update ---Dr. Lance Trexler, BIAI ChairpersonDr. Lance Trexler, BIAI ChairpersonDr. Lance Trexler, BIAI Chairperson

Evidence Based Pharmacological

Evidence Based Pharmacological

Care of Behavior and Cognition

Care of Behavior and Cognition

Presented by Dr. Flora Hammond

Presented by Dr. Flora Hammond

Brain injury often causes day-to-day challenges memory, problem solving, multi-tasking, thinking, controlling behavior that may persist as long term obstacles to quality of life, relationship satisfaction, and social acceptance. This presentation will go over the basic background on how medications work and how they may be used to help cognitive and behavioral function, and then review the studies and current practices in this area, providing an approach to thinking through what medications may be helpful following brain injury.

Barriers to Recovery

Barriers to Recovery

Presented by Dr. Taryn Stejskal

Presented by Dr. Taryn Stejskal

Throughout the process of healing, many family members and survivors encounter barriers that serve as obstacles to optimal recovery after neurological injury. Also, professionals, such as psychologists, marriage and family therapists (MFTs), and social workers may wonder about the most effective mechanisms to engage families and survivors and overcome issues that stand in the way of progress. This presentation is meant primarily for professionals who wish to learn about additional tools that can be used to overcome perceived individual or systemic resistance to treatment. During this presentation, resistance will be explained as a phenomenon that exists within the clinician-client relationship. Also, specific strategies for reducing resistance will be explored.

Brain Injury Rehabilitation:

Brain Injury Rehabilitation:

An Approach to Return to Work or School

An Approach to Return to Work or School

Presented by Dr. William Arnold

Presented by Dr. William Arnold

This session will address issues involved in return to work or school for individuals with brain injuries. The session will discuss the obstacles involved in return to work or school. A model assessment of the needs of a particular brain injured individual as well as the presentation of a model for intervention to assist the individual in returning to work or school.

Problem Solving/Goal Setting

Problem Solving/Goal Setting

Presented by Dr. Taryn Stejskal

Presented by Dr. Taryn Stejskal

This presentation will focus on common problems encountered after injury and how survivors and families can become more effective problem solvers. In addition, after injury, most people have a number of goals to heal and resume a more productive lifestyle that may include returning to work or school, being able to better care for oneself, learning to control anger and frustration, etc. This presentation will also focus on how to evaluate and set reasonable goals. Information is specifically geared toward survivors and family members, but professionals may also enjoy learning new strategies to work with their clients. Also, interactive activities will be conducted to solve problems and set more reasonable goals during the presentation.

11:45 - 1:00 pm

LUNCH WITH BIAI BOARD MEMBERS AND ASSOCIATION AWARDS

LUNCH WITH BIAI BOARD MEMBERS AND ASSOCIATION AWARDS

LUNCH WITH BIAI BOARD MEMBERS AND ASSOCIATION AWARDS

10:30 - 11:45 am

CONCURRENT EDUCATIONAL SESSIONSCONCURRENT EDUCATIONAL SESSIONSCONCURRENT EDUCATIONAL SESSIONS

1:00 - 2:15 pm

CONCURRENT EDUCATIONAL SESSIONS

CONCURRENT EDUCATIONAL SESSIONS

CONCURRENT EDUCATIONAL SESSIONS

9:00 -10:15 am

Keynote Address

Keynote Address

Presented by Dr. Flora Hammond

Presented by Dr. Flora Hammond

Challenges & Strategies in Predicting Outcomes of Severe Brain Injury Challenges & Strategies in Predicting Outcomes of Severe Brain Injury Challenges & Strategies in Predicting Outcomes of Severe Brain Injury

Presentation Objectives: Discuss the needs and uses of outcome predication; explain the pitfalls in predicting outcomes; identify some of the prognostic factors used in outcome prediction and understand limitations in use;

discuss strategies in outcome predication.

Predicting the outcomes from severe traumatic brain injury has implications for clinical care, resource allocation, research outcome, and family counseling. Over the years we have found several apparent markers of recovery, at least when applied in the general sense. However, translating research in this area into the practice of outcome prediction has significant challenges. When applied on an individual level one must consider the inherent inaccuracies and any potential harm of such “guesses”. Outcome predictions are powerful in that they have the potential to guide expectations and thereby impact resource allocation. Several important obstacles exist to being able to accurately predict outcomes. The role of outcome prediction, pitfalls, and implications will be reviewed. Case examples will be presented and the audience will use the information presented to make outcome predictions.

10:15 - 10:30 am

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The Role of Neuropsychological Assessment in

The Role of Neuropsychological Assessment in

Vocational Return:

Vocational Return:

Presented by Dr. Jeffrey Allen

Presented by Dr. Jeffrey Allen

The presentation will focus on the utility of neuropsychological assessment in predicting and preparing for vocational re-entry following brain injury. The current literature on vocational prediction following TBI will be reviewed. The primary focus of the presentation will be providing attendees with specific and relevant methods for using neuropsychological tests to inform vocational re-entry.

The Social Construction of Disability and It’s

The Social Construction of Disability and It’s

Impact on Quality of Life of Individuals with

Impact on Quality of Life of Individuals with

Disabilities:

Disabilities:

Presented by Dr. Julie Lynn Williams

Presented by Dr. Julie Lynn Williams

To conceptualize clinical issues seen in disability populations as related to and a function of social constructions. Main objectives include: Develop an understanding as to the social/political/spiritual influences on the disability experience and quality of life through a historical view of disability. To facilitate understanding of disability as a socially constructed experience as exemplified through disability models. Develop a better understanding as to the interaction of the psychosocial aspects of disability and implications for psychological interventions and specifically rehabilitation psychology.

SCHEDULE

SCHEDULE

SCHEDULE -

-

-

Thursday, October 14th

Thursday, October 14th

Thursday, October 14th

2:30 - 3:45 pm

CONCURRENT EDUCATIONAL SESSIONSCONCURRENT EDUCATIONAL SESSIONS

CONCURRENT EDUCATIONAL SESSIONS

3:45 - 5:00 pm

CONCURRENT EDUCATIONAL SESSIONSCONCURRENT EDUCATIONAL SESSIONS

CONCURRENT EDUCATIONAL SESSIONS

Vocational Trials for Military and Civilian

Vocational Trials for Military and Civilian

Populations with Traumatic Brain Injuries

Populations with Traumatic Brain Injuries

at Paintings & Prose: A

at Paintings & Prose: A

Combined

Combined

Art

Art

Gallery and Bookstore

Gallery and Bookstore

Presented by Victoria HardingPresented by Victoria HardingPresented by Victoria Harding

This presentation will provide an overview of the Defense and Veterans Brain Injury Center at Virginia NeuroCare Inc., with a focus on vocational rehabilitation programming, including therapeutic objectives, assessment,

task analysis and training program in work environments of enclave, advocacy and supported employment. Discussion will include successes in situational & job site assessments, cognitive strategies, job coaching and community partnerships.

INDATA Assistive Technology

INDATA Assistive Technology

Presented by Wade Wingler

Presented by Wade Wingler

The INDATA Project at Easter Seals Crossroads offers a wide variety of assistive technology services throughout the state of Indiana. Join the staff of The INDATA Project to learn about Indiana’s largest assistive technology equipment library, training opportunities and funding for assistive technology.

2:15 - 2:30 pm

BREAK WITH EXHIBITORS

BREAK WITH EXHIBITORS

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SCHEDULE

SCHEDULE

SCHEDULE -

-

-

Friday, October 15th

Friday, October 15th

Friday, October 15th

8:00 - 8:30 am

BREAKFAST WITH EXHIBITORSBREAKFAST WITH EXHIBITORS

BREAKFAST WITH EXHIBITORS

8:30 - 10:00 am General Session

Brain Injury Multi

Brain Injury Multi

-

-

Agency Partnership:

Agency Partnership:

Rehabilitation Case Studies on Two People with Brain Injury

Rehabilitation Case Studies on Two People with Brain Injury

Chaired by: Senator Pat Miller, Chairperson, Health Finance Committee

Discussants: Flora Hammond, M.D., Chair, Department of PMR, Indiana University School of Medicine

Sandra Knutson, Principal Research Analyst, TBI Technical Assistance Center, NORC at the University of Chicago The concept of the Brain Injury Multi-Agency Partnership was developed to facilitate collaboration between providers and various agencies to address the gaps in service delivery to provide in-state solutions to the rehabilitation needs of people with brain injury. Collaboration of multiple agencies provides for the opportunity to provide a patient-and diagnosis-specific rehabilitation program. A case study will be presented with the rehabilitation team and representatives of the participating agencies so as to illustrate potential collaboration and problem-solving. Discussion will be focused on promoting awareness across agencies that can be integrated and coordinated to achieve optimal outcome with in-state resources. Goals: To promote awareness benefits of multi-agency collaboration to address the rehabilitation needs of people with brain injury; to discuss innovative partnerships and collaboration to improve service delivery; to examine strategies to improve outcomes, efficiency of service delivery and utilization of available resources.

11:30 - 12:30 pm

CONCURRENT EDUCATIONAL SESSIONS CONCURRENT EDUCATIONAL SESSIONS CONCURRENT EDUCATIONAL SESSIONS

VBA and VHA and VR

VBA and VHA and VR

VBA and VHA and VR

Presented by John MyersPresented by John Myers

Presented by John Myers

This session will focus on the relationship between the VBA (Veterans Benefits Administration), VHA (Veterans Health Administration) and Vocational Rehabilitation & Employment services. It will include information on the Department of Veteran Affairs in general, as well as the services and providers of services VA has for veterans who are experiencing the effects of TBI.

Patients, Caregivers and Online Social Networks

Patients, Caregivers and Online Social Networks

Patients, Caregivers and Online Social Networks

Presented by Dr. Gabe BossletPresented by Dr. Gabe Bosslet

Presented by Dr. Gabe Bosslet

Online social networks have changed the way many people communicate. These technologies have provided a new, semi-private forum which allows people to make connections that they previously may not have had the opportunity to pursue. While these technologies hold some promise for new mechanisms of communication between patients and caregivers, these interactions may blur the professional-patient boundary in ways that are detrimental to patient-caregiver relationships. This talk will outline the role of online social networks in patient care and some of the concerns regarding possible negative consequences to these interactions.

10:00 - 10:30 am

BREAK/LAST CHANCE SILENT AUCTIONBREAK/LAST CHANCE SILENT AUCTION

BREAK/LAST CHANCE SILENT AUCTION

Chemical Dependence: An Unintended

Chemical Dependence: An Unintended

Consequence of Traumatic Brain Injury

Consequence of Traumatic Brain Injury

Presented by Dr. James Gaither

Presented by Dr. James Gaither

Chemical Dependence is considered a primary, chronic, neurobiological disease, with genetic, psychosocial and environmental factors contributing to its development. The impact of traumatic brain injury, its treatment, and its sequelae, immensely alters the equilibrium of the delicate homeostasis of drive, reward, emotion, impulsivity, and executive function; this often results in the development or unmasking of the disease of addiction. Many of the factors contributing to this altered homeostasis cannot be modified by the health care provider, others

can. This presentation will address the underlying neurophysiology of addiction, the impact of traumatic brain injury,

and some strategies that may be useful in the prevention, treatment, and management of addictive disease in the brain injury patient.

Indiana HRSA Grant Update

Indiana HRSA Grant Update

Presented by Rehabilitation Hospital of Indiana Foundation

Presented by Rehabilitation Hospital of Indiana Foundation

Grant Project Team

Grant Project Team

2010 marks the second year in Indiana of the Health and Resources Services Administration’s four year TBI Implementation Grant. During this presentation attendees will be provided a summary of accomplishments for the current Indiana HRSA Grant, information about the development of Local Support Networks with specific attention to the relationship between the Local Support Networks and the Brain Injury Association of Indiana. The provision of Resource Facilitation in Indiana and the vision of where the HRSA Grant is taking Indiana will also be explored during the session.

10:30 - 11:30 am

CONCURRENT EDUCATIONAL SESSIONS CONCURRENT EDUCATIONAL SESSIONS

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AMERICAN ACADEMY FOR THE CERTIFICATION

AMERICAN ACADEMY FOR THE CERTIFICATION

OF BRAIN INJURY SPECIALIST (AACBIS)

OF BRAIN INJURY SPECIALIST (AACBIS)

Impacting the Brain Injury Community through National Certification

What:

The American Academy for the Certification of Brain Injury Specialists, AACBIS, has partnered with

brain injury experts to design two levels of certification: Certified Brain Injury Specialist Trainer (CBIST) and

Certified Brain Injury Specialist (CBIS). The certification process is based on state of the art theories and a

multidisciplinary treatment approach.

Who: Brain Injury Association of Indiana,

BIAI, is hosting a training seminar for

CBIS

Certification.

CBIS eligibility and certification requirements

include a minimum of 1 year full time or

2 years part time paid employment working directly with individuals with a brain injury and a high school

diploma or the equivalent. An application must be completed and submitted to BIAI by

Wednesday,

September 15, 2010

allowing 4 weeks for review and approval by the

Brain Injury Association of

America (BIAA).

When: Wednesday, October 13, 2010

the BIAI will host a pre-conference AACBIS training and

examination session from

9:00 am-5:00 pm.

A lunch break (lunch on your own) will occur from

1:00 –2:00 pm.

How:

CBIS training will occur from 9:00 am. – 3:00 pm. and will include group discussion, sample case

studies and sample test questions. The certification examination will be administered from 3:00 pm to 5:00

pm. Prior to the seminar, candidates must obtain and study the AACBIS manual.

Cost:

$275.00 per individual (set by the Brain Injury Association of America). If group size exceeds 5

individuals, the cost reduces to $175.00 per individual.

For AACBIS participants and BIAI members, the BIAI annual conference fee reduces to $100.00.

For Further Information Contact Casey Roell at

(317) 356-7722 or casey@centraloffice1.com

AACBIS TRAINING

AACBIS TRAINING

AACBIS TRAINING

Wednesday, October 13th

Wednesday, October 13th

Wednesday, October 13th

12:45 - 2:00 pm

LUNCH with MASTER SERGEANT JEFF MITTMAN

LUNCH with MASTER SERGEANT JEFF MITTMAN

LUNCH with MASTER SERGEANT JEFF MITTMAN

2:00 - 4:00 pm General Session

Indiana Initiatives in Brain Injury: The Statewide Action Plan

Indiana Initiatives in Brain Injury: The Statewide Action Plan

Indiana Initiatives in Brain Injury: The Statewide Action Plan

A Coalition of the Board of Directors of the Brain Injury Association of Indiana, Indiana Spinal Cord

A Coalition of the Board of Directors of the Brain Injury Association of Indiana, Indiana Spinal Cord

and Brain Injury Research Fund, The Leadership Board of the Indiana 2009

and Brain Injury Research Fund, The Leadership Board of the Indiana 2009

-

-

2013 HRSA Grant and

2013 HRSA Grant and

the Home Health Care Task Force

the Home Health Care Task Force

Discussants: Flora Hammond, M.D., Chair, Department of PMR, Indiana University School of Medicine

Sandra Knutson, Principal Research Analyst, TBI Technical Assistance Center, NORC at the University of Chicago

This interactive session is designed to promote awareness of the mission and activities of the three Boards

and the Task Force. Presentations by the Boards and Task Force will be followed by discussion of the areas

of synergy and opportunity for researchers, health care providers, state agencies and consumers.

This session will establish a forum for developing a new Indiana Statewide Plan for Brain Injury.

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Please check if you do not want your contact information included in an attendee directory.

CONFERENCE REGISTRATION FORM

CONFERENCE REGISTRATION FORM

CONFERENCE REGISTRATION FORM

Please check appropriate category: Before 10-1-10 After 10-1-10 & Onsite PROFESSIONAL—BIAI Member _____$175.00 _____$200.00

PROFESSIONAL—Nonmember _____$200.00 _____$250.00

STUDENT (HS, Undergraduate, Graduate) _____$ 55.00 _____$ 75.00

AACBIS Training _____$275.00

BIAI Member Registration plus AACBIS Training _____$375.00 (savings of $75.00) If golfing, please add applicable fee here: $_____________

Total Payment: $ __

Method of Payment (Select One): ___Check ___ MasterCard ___Visa If paying by check, please make check payable to BIAI.

Card Number: Expiration Date: Sec. Code: Name on Card: Signature:

Please check the CEU that applies:

□ Case Management (CMM) □□ Psychology (PhD / PsyD) □□ Speech Language Pathology (SLP)

□ Indiana Social Work, Marriage and Family Therapist, and Mental Health Counselor (LSW, LCSW, LMFT, LMHC)

□ Occupational Therapist (OT)

□ Certificate of Attendance for ___________________________

□ Certificate of Attendance for ___________________________

*You must register BEFORE October 1st to receive the discounted rates shown above.

Please fax registration form & payment to 317-481-1825 or mail to:

BIAI

c/o

Fall

Conference

PO

Box

24167

Indianapolis,

IN

46224

Questions about registration?

Call BIAI Central Office at 317-356-7722.

Other Questions?

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Three ways to register by October 1st:

Complete and fax this form to the BIAI office at (317) 481-1825

Register online on the BIAI website (www.biausa.org/Indiana)

Mail this form along with payment made payable to BIAI - PO Box 24167, Indianapolis, IN 46224-0167

Name: If paying for other golfers, please list names: Company:

Address:

**Individual golfers will be randomly assigned to other groups.**

Phone: Email:

Method of Payment (Select One): ___Check ___ MasterCard ___Visa

Card Number: Expiration Date: Sec. Code: Name on Card: Signature:

Please check the appropriate box(es):

Single Entrant $75 Reception Only $15 Foursome $300 I cannot attend,

Foursome & Hole Sponsor $400 please accept my donation of $___________ Hole Sponsor $100 Give-away item sponsor (Limit 4) $700

Beverage Cart Sponsor (Limit 4) $400 Golf Outing Title Sponsor $1500

♦Please contact BIAI Central Office, with additional questions at (317) 356-7722 or casey@centraloffice1.com♦

 

GOLF REGISTRATION FORM

GOLF REGISTRATION FORM

GOLF REGISTRATION FORM

-

-

-Wednesday, October 13

Valle Vista Golf Club in Greenwood

-

755 East Main Street - Greenwood, Indiana 46143

Exhibitors, Sponsors, and Attendees:

BIAI Board of Directors, fellow BIAI members, and providers are

scheduled to attend! This is a great opportunity to network with the

Brain Injury Association and foster new relationships!

$75 per player includes:

Range Balls

Cart

18 Holes of Golf

Awards

Beverage Cart

Giveaways

Reception

Networking Opportunities

SCHEDULE

1 pm Registration

2 pm Shot Gun Start

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PO Box 24167 Indianapolis, IN 46224 Phone: 317.356.7722 Fax: 317.481.1825

THANK YOU YEAR ROUND

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