Mail-in Registration Form

Teaching Parents to Be Communication Partners:
The Effectiveness of Parent-Implemented Language Interventions
Dr. Megan Roberts
Friday, May 16, 2014

Please fill out and print the registration form below. Payments should be check or money order made payable to Calvin College.


Registrant Information

First Name:
Last Name:
Email Address:
Home Address:
Job Title:
Institution Address:
Preferred Address: Home
Daytime Phone:
First and last name as you would like it to appear on the nametag:

Special Needs

Do you have any special needs (dietary, accessibility, or other)? If so, please list.
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

Pre-registration is required. Registration includes conference materials, breakfast, lunch and refreshments.

CEU Information forthcoming.

$30 Student Registration
$55 Registration
$65 Registration and ASHA CEUs (Intermediate Level, Professional area).
$70 Registration and MI State Board CEU
$80 Registration and BOTH ASHA and MI State Board CEUs
Notes, comments, or questions:

Cancellation Policy: Cancelled registrations will be refunded, less a $15 cancellation fee if cancelled before April 26, 2014.

If you have any questions, please contact us at:
Seminars @ Calvin
1855 Knollcrest Circle SE
Grand Rapids, MI 49546-4402
(616) 526-8558