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REGISTRATION FORM: COURSE SELECTION: ASHA # Name on Conference Badge: Profession: Organization/Employer: BIlling Address: CIty, State, Zip Code: Day Time Phone Number: Email Address: Do you require special assistance? How to Register: Credit Card: Card Holder's Name: Card Number and Expiration Date (MM/YY): Security Code On Back: COURSE PRICING: FEES: $495.00 Videostroboscopy: $495.00 (BOTH) FEES and Videostroboscopy Course Combined Discount Offered for total of: $940. 2 Day Added Passes Course: $450.00 DALLAS, TX SPECIAL! 2 Day FEES: $495.00 1 Day Added Passes: $250.00 Full 3-Day FEES & Added Passes: $745.00 TOTAL AMOUNT TO BE CHARGED IS: SIGNATURE REQUIRED: OUR OFFICE WILL CONTACT YOU TO CONFIRM YOUR REGISTRATION! PLEASE CONTACT US WITH ANY QUESTIONS: Office 339-309-9508. "Refer to our brochure for our refund policy."
Dallas, TX | June 22-23 | FEES 2-Day
Dallas, TX | June 24 | ADDED PASSES 1-Day
Dallas, TX | June 22-24 | All 3 Days FEES & ADDED PASSES
Laconia, NH | July 21-22 | Videostroboscopy 101
Des Moines, IA | September 15-16 | ADDED PASSES 2-Day