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)
Sue Thompson & Dr. James Loomis - $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 February 2, 2001. No refunds will be made thereafter.

Parents of children with NLD: We will be arranging with a local restaurant for all of the parents to have dinner together on the Monday 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

  

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

 

WARNING!!!

Past experience has taught us –
this conference WILL be full.
Register NOW to save your spot!

 

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

 

~~~~~~~~~~

 

IMPORTANT CONFERENCE INFORMATION FOR ATTENDEES 

 

APA cont. ed. credits expected (12 for two days), in process.

All confirmation packages (which will include directions) will be mailed ON Friday, February 2, 2001. Prior to this you should assume that you are registered unless your check is returned to you immediately upon its arrival to our office. If you have NOT received your confirmation package by Friday, February 9, 2001, you should contact the office (802-446-3577) to ensure that your registration information was received. *Note: If you include your e-mail address, we will e-mail you immediately upon receipt of your registration.

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

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 February 2nd so that we may provide you with appropriate service.

 

~~~~~~~~~~

 

To ensure availability please book your room TODAY!

DOUBLETREE HOTEL
San Antonio, Texas
$119.00 US/night (plus tax)
Call 210/ 366-2424

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

~~~~~~~~~~

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