Creating meaningful opportunities that enrich the lives of people with autism, their families and their communities.

Autism Services Inc.

Thank You

Thank you for registering for our Fall Virtual Workshop.
Please complete the following information if applicable.

If you registered only for yourself, and you are not an SLP or Audiologist or a Parent/Other Professional/Student, you do not need to complete this form.

If you registered only for yourself, and you are an SLP or an Audiologist – please enter your ASHA account number below.

Parents/Other Professionals/Students – Please indicate below if you would like to recieve a certificate of attendance.

If you have submitted multiple registrations, please indicate the following:
1 – Enter your name in “Registration Completed By:” field
2 – Enter the names of the other registrants, their email addresses, their disciplines (if applicable), and their ASHA account number (if an SLP or Audiologist).
3 – Enter your email in case we have questions.

SLPs and audiologists will receive certificates of attendance upon receipt of their ASHA CE Participant Form and Course Evaluation following completion of the workshop.

OTs/COTAs/PTs/PTAs will receive certificates of attendance upon the receipt of post-workshop forms following completion of the workshop.

 






Registration Completed By: (required)

Registration is for the following (include name(s), email address(es), and discipline(s) (if applicable):

ASHA account number (if applicable)

Parent/Other Professional/Student: Indicate if you would like a certificate of attendance.

YesNo

Your Email (required)

Autism Services Inc.

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