Registration Form
Curriculum-Based Narrative Language Intervention

TWO WAYS TO REGISTER:
1. Fill out and mail in the registration form below. Send one registration form per person along with your payment to the address below. Payments should be check or money order made payable to Calvin College.
2. Register online and pay with credit card or paypal account. Click here for secure, online registration.

Registrant Information (for mail-in registrations)
   
Name (First):
Name (Last):
Name as you would like it to
appear on nametag
Place of Employment:
Discipline/Area of Study:
Home Address:
Institution Address:
Preferred Address: Home
 Institution
Daytime Phone:
Email Address:
   
Special Needs
Dietary:
Accessibility:
Other:
   
How did you hear about this conference?
   
Registrant Contact List
During the conference, we will provide all registrants with a list of names and contact information for all who attend.
I give permission for my name and contact information to be made available to all registrants.
 
Registration Options
Please check only one option.
$50 Registration with a boxed lunch
Do you request CEU credit for this conference?

Yes No
If yes, please bring $10 cash or check with you to the conference for ASHA credit and bring $10 cash or check for State Board CEUs. Please note in the comment section which CEU you are requesting. If you request both, please bring two seperate checks. Checks should be made out to Calvin College.

This conference is offered for .5 ASHA CEUs (beginning level, professional area) and for .5 State Board CEUs.

Notes, comments, or questions:
 
Cancellation Policy: Cancelled registrations will be refunded, less a $15 cancellation fee if cancelled before January 26, 2010.
 

Please print your completed form and send to the address below.
You will receive e-mail confirmation with check-in instructions after we receive your order.
(To register online with a credit card, click here.)

 

To complete your order, please send this form along with payment to:
Seminars@Calvin
1855 Knollcrest Circle SE
Grand Rapids, MI 49546

For questions, you may contact us via phone or e-mail at:
616.526.8558
seminars@calvin.edu