THERE’S ONLY ONE MIZZOURegistration Form Thompson Center 2011 1 st Annual Southeast Missouri Autism Conference Name: __ ____ ____ ____ ______ ____ ____ ____ ____ ____ Organization: __ ______ ____ ____ ____ ____ ____ ____ Address: ___________________________ Ci ty: _______ ______ ____ ____ ____ ____ ______ ____ ___ St at e: ________ __ Zip: ____ ____ ______ ____ ____ ___ Dayt imephone: ___ __ __ ____ Emai l: __ __ __ __ __ Conference Informati on: Registration table will be open from 7:00-8:15am each day of the conference Please check the following based on your attendance to the conference: Attending both days Only Thursday (6/24) Only Friday (6/24) On the following page, please check your preference for specific workshops on Thursday afternoon and Friday. How to Register: 1.Online at: www.semissouriautism.com (complete registration online andemail to [email protected])2.Mail completed form (2 pages) to: Thompson Center c/o Leanne Hopper 611 N. Fountain St. Cape Girardeau, MO 63701 3.Fax completed form (2 pages) to: (573) 986 -4994 Registration Questions: If you have any questions about this form or how to register please call Jamie Brazer @ MU Thompson Center at (573) 225-5828 or email [email protected]
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Daytimephone: _____________________________ Email: ________________________________________ Conference Information: Registration table will be open from 7:00-8:15am each day of theconference
Please check the following based on your attendance to the conference: Attending both days Only Thursday (6/24) Only Friday (6/24)
On the following page, please check your preference for specific workshopson Thursday afternoon and Friday.
How to Register:1. Online at: www.semissouriautism.com (complete registration online and
Registration Questions:If you have any questions about this form or how to register please call Jamie Brazer @MU Thompson Center at (573) 225-5828 or email [email protected]