JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Educational Therapists of the Carolinas Membership Form
Annual Membership fee is $25. Please make checks payable to Educational Therapists of the Carolinas mailed to 16152 Haroa Court, Tega Cay, SC 29708 or request a PayPal link to pay online.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name
*
Your answer
Phone Number
*
Your answer
Mailing Adress
*
Your answer
Is this a membership renewal?
*
Yes
No
What therapy/certification level do you provide? Check all that apply.
*
NILD Level I
NILD Level II
NILD Level III
Orton Gillingham Classroom Educator
Orton Gillingham Associate Level
Orton Gillingham Certified Level
Orton Gillingham Fellow Level
CERI (Center for Effective Reading Instruction) Certification
Academic Coach
Search and Teach
Occupational Therapist
Nutritionist
Physical Therapist
seeking training
Other:
Required
What other organizations and techniques or therapies are you involved in?
*
Your answer
What type of practice are you in?
*
Choose
Private Practice
Practicing in a school
If practicing in a school, which school?
Your answer
If private practice, where is your practice?
Your answer
Would you like to register for the February 1, 2020 Winter Conference: Embracing the Whole Child? Pre- registration is $45 and includes lunch.
*
Yes
No
Maybe. Please send more information.
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
