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Suggestions ...

Please indicate your discipline:

OT PT SLP Special Ed. Psychology Nursing Parent

Other (Please Specify:

 
Is there a specific topic that you would like to see addressed?  If so...please list it below. Also...do you have a suggestion for a specific speaker to address it?
 
Where would you like to see this course held? Would your facility be interested in hosting this course?
 
What would be the best time of the year to hold this course?
 
Would you be interested in helping us organize it? If so, please be sure to give us your name and telephone number.
               
Your Name    
Last Name:   
First Name:  
Your E-mail address:  
Your Telephone #:  
Your Fax #: