Implementing Social Thinking Concepts and Vocabulary: A Day to Develop Team Creativity Registration Form

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Presenter: Nancy Clements, MA, CCC-SLP

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Last Name (please use last name to be printed on certificate of completion) *

First Name (please use first name to be printed on certificate of completion)

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Speech Language Pathologist

Occupational Therapist

Occupational Therapy Assistant

Social Worker

Licensed Marriage and Family Therapist

Educator

Parent

Other:

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Email from Therapy Funplace

Social Thinking Website

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If group rate selected, each group member must fill out their own registration form in addition to having names listed below. Please list ALL group member names in order for each member to receive group rate.

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I understand that registration is not complete until I have emailed the credit card authorization form to office@therapyfunplace.com or faxed it to (800)570-6799. The authorization form must be submitted by January 13th in order to receive discounted rate.

I understand that Therapy Funplace reserves the right to cancel this course due to reduced demand, weather or unforeseen circumstances. In the event that the course is cancelled, Therapy Funplace will notify registrants by email at least one calendar day before the event, and no workshop fee will be charged. Therapy Funplace is not responsible for any additional fees incurred to participants in the event that this workshop is cancelled.

I understand that there is a no refund policy. If I cannot attend for any reason, no refund will be issued. I may send another attendee in my place if approved by Therapy Funplace.

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