Together we can solve the puzzle

South Carolina Autism Society

Workshop Registration Form

* All Fields Required.
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* Your Name
* Your Address 1
Your Address 2
* Your City    * State       * Zip Code   
* Phone Please include area code.
* Your E-mail (Changes will be sent by email.)

YES

NO

* Please indicate
which category
best describes you:
Parent Medical Professional
Service Provider Family Member    
Educator Individual with Autism
Other: 

Select Sessions You Wish to Attend:

Select Workshop

Session Name

Location

Date

No Refunds
After Date

Fee Includes
Lunch:

Registration
Fee

Preparing Students for the Real World: A Full Day Workshop on Transition (9:00am-4:00pm)

Columbia Conference Center
169 Laurelhurst Ave.
Columbia, SC

Thursday, 03/25/10

03/11

Yes

$75

  CEU Fee (Optional) / $20

Autism 101(6:00pm-8:00pm)

SCAS-HQ
West Columbia, SC

Wednesday, 04/07/10

Not Applicable
Cancellation notification is appreciated.

No

$0

Home-School Collaboration in Positive Behavior Support for Students with Autism: Challenges and Opportunities (9:00am-4:00pm)

Columbia Conference Center
169 Laurelhurst Ave.
Columbia, SC

Thursday, 06/10/10

05/27

Yes

$75

  CEU Fee (Optional) / $20

Autism 101(6:00pm-8:00pm)

SCAS-HQ
West Columbia, SC

Wednesday, 07/14/10

Not Applicable
Cancellation notification is appreciated.

No

$0

Autism 101(6:00pm-8:00pm)

SCAS-HQ
West Columbia, SC

Wednesday, 10/27/10

Not Applicable
Cancellation notification is appreciated.

No

$0

* Cancellation fee (if cancelled before refunds date above) $10/session

   *Payment Type:

Check (mailed) Check #:

Money Order (mailed) MO #:

Purchase Order (mailed) PO #:

Payment by Credit Card

A limited number of Scholarships for PARENTS are available at no cost for some workshops. Early requests are strongly recommended. Scholarship requests also can be faxed (print this form including pertinent information and fax it to 803-750-8121).