Smart Ears

Please Choose the Workshop Date: *
I would like to register for the CATCH UP! workshop (April 16, 2015)

Your Name: *


Your Email: *


Alternate Email: Optional - Please provide a personal, non-school, email such as Gmail or Yahoo (as a backup)


Your Phone Number: *


Your Organization: *


City, State: *


Your Title: *


You work primarily with *
Infants & Toddlers
Preschoolers
Elementary
Other

Primary Modality Used in Therapy/Teaching: *
Total Communication
Cued Speech
Auditory-Oral
Auditory-Verbal
Other (including ASL)

You are a: *
Teacher of the Deaf
SLP
Special Educator
Audiologist
Other

Do you have the pre-requisite knowledge for attending this workshop? *
Yes
No