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Behavioral and Educational Consulting for Children with Autism Spectrum Disorders

REGISTRATION
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REGISTRATION

Print out the registration form below and mail with a check (made payable to Anderson Behavioral Consulting) to:
 
Anderson Behavioral Consulting
638 Watervliet Ave.
Dayton, Ohio 45420
 
Registration deadline: April 1, 2008

Let's Have a Potty Party- A Potty Training Workshop

 

REGISTRATION FORM:

 

Name: ________________________________________________________

 

Address: _____________________________________________________

 

Phone #: _____________________________________________________

 

About your child/person you are attending for:

(parent, sibling, therapist, teacher, etc., INCLUDE THE AGE AND DISABILITY OF THE INDIVIDUAL- if applicable) ________________________________________________________________

 

Number attending:  _________________

 

How did you hear about this workshop (be as specific as possible, please J)

 

________________________________________________________________________________________________________________________________________________           

 

 

Cost: 

            _____ Family registration ($25/individual or couple;

$10 for each additional applicant)

 

            _____ Professional registration ($25/person)

 

 

 

Send completed registration form and check BY APRIL 1, 2008 (made payable to Anderson Behavioral Consulting) to:

 

 

 

Anderson Behavioral Consulting

638 Watervliet Ave.

Dayton, Ohio 45420

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