Registrant Information
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| Prefix: |
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| First Name: |
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| Last Name: |
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| Email Address: |
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| Home Address: |
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| Job Title: |
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| Company/Organization: |
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| Institution Address: |
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| Preferred Address: |
Home
Institution |
| Daytime Phone: |
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| FAX: |
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| First and last name as you would like it to
appear on the nametag: |
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Special Needs
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| Do you have any special needs (dietary, accessibility, or other)? If so, please list. |
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| How did you hear about this conference? |
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Registrant Contact List
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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.
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Registration Options
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Pre-registration is required. Registration includes conference materials and refreshments.
This conference is offered for .3 ASHA CEUs (beginning level, professional area). State Board CEUs are not offered for this event. |
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$20 Registration |
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$10 Student Registration |
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$30 Registration and .3 ASHA (American Speech-Language-Hearing Association) CEUs |
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| Notes, comments, or questions: |
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Cancellation Policy: Cancelled registrations will be refunded, less a $15 cancellation fee if cancelled before November 23, 2012.
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If you have any questions, please contact us at:
Seminars @ Calvin
1855 Knollcrest Circle SE
Grand Rapids, MI 49546-4402
(616) 526-8558
seminars@calvin.edu
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