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PEDIATRIC COURSE REGISTRATION Mail to: Ages and Stages®, LLC
11390 Patores St.
Las Vegas, NV 89141
Fax to: 702-914-3414 Phone: 702-845-0642 Name (Print)_______________________________
Address___________________________________
City________________State________Zip_______
E-mail address______________________________
Phone_____________________________________
Occupation_________________________________
Employer__________________________________
Enclosed is the workshop fee of
$325 or $299 (early registration 3 weeks prior)
HOUSTON, TX – February 26 & 27, 2010
BATON ROUGE, LA – March 5 & 6, 2010
MEMPHIS, TN – April 16 & 17, 2010
LITTLE ROCK, AR – April 23 & 24, 2010
PITTSBURGH, PA – May 14 & 15, 2010
COLORADO SPRINGS, CO – June 25 & 26, 2010
Checks should be made payable and sent to:
Ages and Stages®, LLC
11390 Patores Street
Las Vegas, NV 89141
For credit card payments:
VISA Mastercard Discover
Credit Card #_____________________________
V-Code (last 3 digits on back of card) _______
Exp. Date ________________________________
Your Signature___________________________
Address above needs to be same as card
o School or business Purchase Order attached
o Discount $10 pp. 3 or more registering together
Confirmation will be sent by e-mail unless otherwise requested.
Refund or Cancellation: A full refund will be given up to two weeks prior to the workshop less a $25 processing fee. After that date no refunds will be given but amount may be applied to any future workshop.
Ages and Stages®, LLC reserves the right to cancel this workshop for insufficient registration or unforeseen circumstances. Cancellation of workshop will result in a full tuition refund. However, Ages and Stages®, LLC will not be responsible for financial loss due to cancellation including airline and hotel accommodations.
Reasonable accommodations will be made for individuals with disabilities. Please contact us if you need special consideration.
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This course is offered for 15 Contact Hours toward Licensure: 1 teaching hour equals 1 contact hour/PDU. Programs offered by Ages and Stages®, LLC have been approved by Arizona (SLP), California (SLP-PDP 188 and OT-APP-S47), and other state licensure boards.
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Ages and Stages®, LLC is an approved provider of continuing education for the American Occupational Therapy Association, Inc. (AOTA). The assignment of AOTA CEUs does not imply endorsement of specific course content, products, or clinical procedures by AOTA.
Courses offered by Ages and Stages®, LLC meet NBCOT requirements for certification renewal. Ages and Stages®, LLC is listed on the NBCOT Professional Development Provider Registry.
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