REGISTRATION INFORMATION
Mail, Fax (702-914-3414), or Call (702-845-0642) to Register
Name (Print)_______________________________
Address___________________________________
City________________State________Zip_______
E-mail address______________________________
Phone_____________________________________
Occupation_________________________________
Employer__________________________________
Enclosed is the workshop fee of $370 for AN INTEGRATED APPROACH TO ORAL MOTOR THERAPY: INFANCY THROUGH GERATRICS
(Check appropriate location and date 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
Enclosed is the workshop fee of $185 for TREATMENT OF SPEECH PRODUCTION DISORDERS AND PROBLEM PHONEMES: GETTING TO CARRYOVER
(Check appropriate location and date below)
o Atlanta, GA – Mar. 9, 2008
o Chattanooga, TN – Mar. 11, 2008
Enclosed is the workshop fee of $250 for SATPAC: A TIME-SAVING APPROACH TO "R" AND "S" REMEDIATION
(Check appropriate location and date below)
o San Francisco, CA – Feb. 23, 2008
Checks should be made payable and sent to:
Ages and Stages, LLC
11390 Patores Street
Las Vegas, NV 89141
Phone: 702-845-0642
Fax: 702-914-3414
For credit card payments:
VISA Mastercard
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 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.
CANCELLATION POLICY:
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.
