Registration Form

 

AEHIÕS Cued Speech Workshops

 

Dates:             Second Saturday of every month on the following dates unless otherwise noted:

 

                        August 13, 2005                                            January 21, 2006 (3rd Saturday)

September 10, 2005                                       February 11, 2006

October 15, 2005 (3rd Saturday)                  March 11, 2006

November 12, 2005                                       April 8, 2006

 

Name:____________________________________________________________________

 

Address:__________________________________________________________________

 

City, State, Zip Code:________________________________________________________

 

Home Phone:_________________________  Work Phone:__________________________

 

Reason for your interest. Please be as specific as possible:  __________________________

 

_________________________________________________________________________

 

_________________________________________________________________________

 

Please schedule me for my workshop on:__________________________ (Enter date)

 

Level of Instruction:    (Space is limited to 20 participants per workshop).

 

_____ Beginning                   _____ Intermediate

 

_____ I am interested in Cued Speech transliterating (interpreting) in a school setting.

 

The registration fee is $75.00 per person per workshop. 

 

PLEASE RETURN THIS FORM AND YOUR PAYMENT TO:

 

AEHI - Workshop Registration

2020 E. Camp McDonald Rd.

Mount Prospect, IL 60056

Voice\TDD: 847-297-3206  Fax: 847-297-3208

Email: info@aehi.org

 

Registration and payment must be received 14 days prior to the scheduled workshop.  Fees are non-refundable.

 

 

Do not write below this line. For office use only.

 

 

Registration recÕd________________      Check #__________ Amount___________

(Mail this page to AEHI at above address)