Raleigh One Day Conference Wake County Public Schools110 Corning Road, Cary, NC 27518 View Map Saturday, March 2, 2019 9:30am – 4:00pm Registration Name* First Last Email* Phone*I am requesting CEUs (for SLPs)* Yes No PricingIndividual: $35.00Family: $45.00SLP-CEUs: $85.00Grad. students: $25.00Wake Co. SLPs rate: $60.00Special SLP registration (with client's family): $50.00Price will increase by $5 after 02/02/2019Billing Address (credit card)* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How many children will you be bringing*012345Below, please specify name, age, and if child stutters or if they're a sibling. ex. Maria, 10, stutters ex. Tommy, 8, sibling ex. Mike, 13, sibling Name, age, stutters/siblingName, age, stutters/siblingName, age, stutters/siblingName, age, stutters/siblingName, age, stutters/siblingPlease check all that apply:* I am an adult who stutters I am a parent I am an SLP I am a student Other How did you hear about this conference?Make a small contribution to FriendsFRIENDS is a non-profit, primarily volunteer grassroots organization that is sustained entirely by the fundraising efforts of its supporters. We invite you to add an optional $5, $10, or $20 donation (or other amount) to your registration to support the Friends mission of enriching the lives of children who stutter and their families.$5$10$20OtherOther donation amount Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Total $0.00 Above total is based on the One-Day Conference you have chosen to attend, and the type of registration. Refund Policy: Registrations may be refunded up until 24 hours prior to the conference. Please send an email to kevin@friendswhostutter.org to initiate a refund. PLEASE NOTE: By entering and attending this event, you acknowledge and agree that your likeness may be included in photos and videos of the event and used by Friends to illustrate and promote Friends and its programs. For questions or concerns, please contact friends@friendswhostutter.orgEmailThis field is for validation purposes and should be left unchanged.
