PO Box 718 • Medina, WA 98039-0718
(800) 260-8180 • Fax: (425) 453-4103
www.iedseminars.org • register@iedseminars.org

XT95S1-CEN

Seminar Registration Form

School-Based OCCUPATIONAL THERAPISTS: Practical Early Intervention Strategies and Activities to Support Your Youngest Learners (Pre-K - Second Grade)
Central, , May 1

Pricing Information

Standard Price: $295.00

Group Price: $275.00 Register 3 or more participiants for this seminar at the same time to receive discount.

Group registration? List additional registrants on a copy of this form.

Personal Information
First Name: _________________ M.I. ___ Last Name: ______________________

Position: _________________________________ Grade Level ___________

Priority Code

Important! It is important that you fill in your Priority ID Code from your brochure, even if it was not addressed to you. It is the six digit number on the mail label next to the word "ID".

I have my brochure Priority ID Code: _____________
I don't have my brochure with me
I did not receive a brochure

Your School

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Home Address

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Payment Information

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