8th Annual NLDA Symposium

Posted bytest.drug-addiction
 

March 5-6, 2004 

Best Western Grosvenor Hotel – South San Francisco, CA

(800) 722-7141 for Reservations

 

REGISTRATION FORM

Please print out and return completed form and payment to:
Nonverbal Learning Disorders Association (NLDA)
21001 San Ramon Valley Blvd.,   A4 #175
San Ramon, CA  94583

Phone:  (831) 624-3542 ? Fax:  (831) 624-3266

email:  [email protected]

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First Name:
Middle Initial:
Last Name:
email address:
Company:
Street Address:
City:
State:
Zip:
Day Phone:
Night Phone:
Fax Number:

I am a… (check all that apply)

Educator

MFT

Nurse
Occupational Therapist
Parent
Physician

 Psychologist
  Social Worker
  Speech and Language Pathologist
Other 

How did you hear about NLDA?  (check all that apply)

 

 
    Health Care Professional    Support Group    Received Brochure in the Mail    Website or Search Engine    Other:

PLEASE TOTAL YOUR FEES FOR THE SYMPOSIUM

Friday Only $140  postmarked by  2-14-04 or $160 after  2-14-04
Saturday Only $140  postmarked by  2-14-04 or $160 after  2-14-04
Both Days $260  postmarked by  2-14-04 or $300 after  2-14-04
*Continuing Education Credits (CME’s)*CME’s cover Medical professionals, Psychologists,  MSW’s

SLPAB credits available

 $25.00  (CME credits for one- or two-day participation)
In addition to the above fee(s), your tax deductible NLDA membership (or renewal) is required to attend either or both days of the symposium. 
$50.00 (single)             or              $75.00 (professional / family)
                                                                  TOTAL FEES: $
Please note our REFUND POLICY:  Refunds will be issued (minus a $40 administrative fee) if  we receive notification no later than  3 weeks before the symposium.    NO refunds will be issued for notification after 2-14-04.
Administration Fee for Walk-in Registration (Walk-in registration will be accepted provided space is available.) $40.00 

HOW ARE YOU PAYING FOR YOUR REGISTRATION?

(Please submit payment along with your registration form)

____Personal check, #_______Amount $____________

____Purchase order from school district, #_________Amount $_______