AT Certificate Course - Registration
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Email *
Name of Participant *
Please register each participant separately. List "Attendee 1" if  unknown at this time.
Title / Role of Participant *
What will be the participant's role when they finish the training?
Email Address of Participant *
Cell Phone Number of Participant (in case of emergency) *
School District / Agency *
Name of Billing Contact or Supervisor at School District *
Email Address of Billing Contact or Supervisor at School District *
Registering for: *
I understand that this course covers most areas of assistive technology but does not cover AAC (Augmentative-Alternative Communication.) *
Thank you for registering.
You will receive a copy of this form immediately.
You will receive an invoice with payment information within the next 3 business days.
Please feel free to contact me with any questions. (323) 333-5674
A copy of your responses will be emailed to the address you provided.
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