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AN INTEGRATED APPROACH TO ORAL MOTOR THERAPY: INFANCY THROUGH GERIATRICS (A COURSE FOR OTS AND SLPS) Instructor: Diane Bahr, MS, CCC-SLP, CMT, CIMI
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COURSE REGISTRATION FORM
TO REGISTER:
Mail form to address listed below
Fax form to 702-914-3414
Call 702-845-0642
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Name of Registrant__________________________________
Address (same as credit card)_______________________
City___________________State____________ Zip________
Phone_______________________________________________
Occupation__________________________________________
Employer____________________________________________
Email Address_______________________________________
Place a "check mark" on desired location and dates below: o Long Beach, CA – Feb. 8 & 9, 2008
o San Francisco, CA – Feb. 21 & 22, 2008
o Atlanta, GA – Mar. 7 & 8, 2008
o Chattanooga, TN – Mar. 14 & 15, 2008
o Boise, ID – May 2 & 3, 2008
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WORKSHOP FEE $370
Checks should be made payable and sent to:
Ages and Stages, LLC
11390 Patores Street
Las Vegas, NV 89141
For Credit Card Payment: (Please Check One)
____VISA ____MASTERCARD
Credit Card #__________________________________
V Code(last three digits on back of card)______
Exp. Date ____________________________________
Your Signature _________________________________
Address above needs to be the same as cardholder.
o School or Business PURCHASE ORDER attached o DISCOUNT 5% per person for 3 or more registering together o DISCOUNT 5% for registrations postmarked 30 days prior to workshop date o DISCOUNT $20 when registering for two workshops o AOTA DISCOUNT: AOTA NUMBER ______________ Confirmation will be sent by e-mail unless otherwise requested.
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Workshop participants will receive a textbook and workshop manual.
CANCELLATION POLICY AND OTHER INFORMATION
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 has the right to cancel any course. We are not responsible for expenses incurred by participants if course is cancelled. Reasonable accommodations will be made for individuals with disabilities. Please contact us if you need special consideration. GROUP PRESENTATIONS
Arrangements can be made to give a workshop to a group of ten or more at your location. Call 702-845-0642 for details.
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