Seattle One Day Conference

Name*

First Last

Email*

Phone*

I am requesting CEUs (for SLPs)*

Yes
No

Pricing

Prices will go up by $5 after September 19th, 2019

Billing Address (credit card)*

Street Address Address Line 2 City State ZIP Code

How many children will you be bringing*

Below, 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/sibling

Please 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?

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number 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.org

Email

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