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REGISTRATION FORM FOR 2 Day Comprehensive WORKSHOP on: Autism
& ABA : How it applies to teaching children with Autism -
August 17-18 2009 - Levittown Hall,
201 Levittown Parkway Hicksville NY 11801 (between Stewart & Old Country Rd)
Time: 9 to 4
_____ # of Attendees @ $175
_____ # of Attendees @ $200 if LATE or WALK in (after August 10, 2009)
Total amount enclosed $________
Lite Refreshments in the morning, Lunch on your own
Consider your canceled check as your confirmation, $35.00 cancellation/bounced check fee, Considered late and NON REFUNDABLE 1 week prior to date of workshop
Name (s) _______________________
_______________________________
_______________________________
Address _________________________
_______________________________
Phone ______________________ Email_______________________
Organization or Affiliation (ie: Parent,Speech,Teacher)_____________________
Send Check or Money Order Payable to:
EFFECTIVE INTERVENTIONS
665 Newbridge Road Levittown NY 11756
We also take Visa/Mastercard (circle one) Acct#____________________________ Exp Date:________
Card Holders Signature: _____________________________
Phone:516 433 4202 Fax 516 433 4324 (for information or questions only. Do not fax a reg form)
EMAIL US QUESTIONS-> info@effectiveinterventions.com (do not email any "reserve request" or email reg forms)
