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Registration Information
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Registration Fee:
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$130 Individual
$120 Group Rate
(2 or more, please include all payments together)
$50 Speech-language pathology graduate students
(copy of ID is required to be sent with payment)
Registration Information:
First Name
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Last Name
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Profession
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Reading Specialist
SLP
OT
Speech Assistant
Teacher
Parent
Psychologist
Student
Other
Facility/School Name
*
Street Address
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City
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State
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Zip Code
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Enter either Home or Work Phone Number
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Home Phone
Work Phone
Email Address
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Please specify any accommodations needed (e.g. interpreter, CART, etc.):
For future conferences, please select other topics of interest to you.
Language Learning and Education
Neurogenic Speech and Language Disorders
Augmentative and Alternative Communication
Hearing, Disorders of Hearing, and Aural Rehabilitation
Communication Disorders in Culturally and Linguistically Diverse Populations
Voice and Resonance Disorders
Feeding and Swallowing Disorders
How did you hear about this conference?
Select One
Website
Direct mail
Previous attendee
Word of mouth
ASHA website
Payment and registration information must be received by June 1, 2011. No credit cards or purchase orders accepted.
No refunds will be issued after June 1, 2011.
Please make check payable to CHILDREN'S HOSPITAL BOSTON and return with registration information to:
Hope Dickinson
Children's Hospital Boston at Waltham
Department of Otolaryngology & Communication Enhancement
9 Hope Avenue
Waltham, MA 02453
No confirmation notices will be sent. You will only be notified if there is no space available. Registration is limited. Space will be reserved upon receipt of payment.
For questions, please email us at
Needleman2011@childrens.harvard.edu
