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South Carolina Autism Society

Workshop Registration Form

* 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.)

Are you a:

YES

NO

 |

 

YES

NO

Select Sessions You Wish to Attend:

Select Workshop

Session Name

Location

Date

No Refunds
After Date**

Fee Includes
Lunch:

Registration
Fee

Total

Developing Legally Correct IEPs

Greenville

03/18/08

3/15

No

$ 20

$

Best Practice Series: ABA and Systematic Instruction

West Columbia

Thursdays
04/3-6/5/08

--

No

$ 0

$

Planning for the Future for Yourself and your Child with a Disability

Greenville

05/14/08

5/12

Yes

$ 5

$

Inclusion

Columbia

06/12/08

6/5

Yes

$ 50

$

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

Total Registration Fees (All Sessions)

$

* Name on Credit Card:

* Credit Card Type:

Visa   MasterCard
Discover

* Card Number:

* Expiration Date (MM/YY): 

* V Code:

(3-digit number on back of card)

Notes/Comments:

* Total amount:

$

Due to our website renovation, online registration is unavailable.
You may print the information and mail it to the address below or fax it to 803-750-8121.
You may also call our office, 803-750-6988 OR 800-438-4790, extension 109, and leave a voicemail with registration information requested above. Please be sure to include the seminar name and a contact phone number if you choose this option.

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 ).