NONVERBAL LEARNING DISABILITIES

(Please complete a separate form for each attendee)

PLEASE PRINT

Title:         Dr.       Mrs.       Ms.       Mr.      (please circle)

Last Name: _____________  First Name: _____________

Home Address:  _________________________________

_______________________________________________

City / State / Zip  ________________________________

Home Telephone:  (      )  _________________________

Business Name: _________________________________

Business Address:  _______________________________

_______________________________________________

City / State / Zip  ________________________________

Business Telephone:  (      )  _______________________

Fax:  (     )  _____________________________________

E-mail address: __________________________________

 

Please circle:     Psychologist     Psychiatrist     Teacher
                       Parent             Administrator   Student
                       Other (please specify): _____________

 

Please register me for the following (circle):

Day One (only)
Dr. Byron Rourke & DeAnn Hyatt-Foley - $150.00
(lunch included)

Day Two (only)
Dr. Tony Attwood & Sue Thompson - $150.00
(lunch included)

Day One AND Day Two - $275.00
(lunch included both days) 

Please make check payable to Dr. Dean Mooney. Due to the expected interest level, seating will only be reserved once your FULL payment has been received. 

Refunds: Requests for refunds must be made in writing. A full refund, less a $50 service charge, will be made for requests postmarked by April 2nd, 2001. No refunds will be made thereafter.

Dr. Dean Mooney is not responsible for any presenter’s or participant’s statements, acts, materials, or omissions. The use of audio or video taping devices is NOT permitted.

If you have any special dietary needs or if you require special accommodations due to a disability, please contact the office by April 2nd, 2001, so that we may provide you with appropriate service.

Parents of children with NLD: We will be arranging with a local restaurant for all of the parents to have dinner together on the Thursday evening. The fee for this dinner is NOT included in the conference registration but is a service which in the past has been a highlight for the parents, who found the contacts made here to be a tremendous support LONG after the conference is finished. Please indicate below if you are interested in attending the dinner, by circling the appropriate response.

PARENT DINNER:           YES           NO

 

Books authored by the presenters will be sold each day  - U.S. CASH or CHECK in U.S. funds only.

 

MAIL THIS REGISTRATION FORM &
FULL PAYMENT (CHECK OR P.O.#) TO: 

Dr. Dean J.M. Mooney
270 Olde Pine Lane
Wallingford, VT 05773-9203

 

DIRECT ANY QUESTIONS TO: 

Phone/Fax:  (802) 446-3577
E-mail:        ljmooney@vermontel.net

 

Note:  APA APPROVED - 6 c.e.u.'s for each day for Florida Psychologists (also accepted by Social Workers, Mental Health Clinicians in Florida).

 

 

IMPORTANT CONFERENCE INFORMATION FOR ATTENDEES 

 

All confirmation packages (which will include directions) will be mailed as soon as your registration form and payment is received by our office. 

 

~~~~~~~~~~

 

To ensure availability please book your room TODAY!

CONFERENCE LOCATION

GRENELEFE GOLF & TENNIS RESORT
Orlando (Haines City), Florida
One bedroom villa $129/night (plus tax)
Traditional $99/night (plus tax)

(A limited number of rooms are being held at this
discounted rate. You must BOOK EARLY and mention the
Nonverbal Learning Disabilities conference).

Call (863) 421-5004

Conference flyer    Click here for more detailed information about the speakers and their presentations.

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