Training sessions I plan to attend:
____ 2/11/08 ____4/21/08 ____ 6/16/08 ____8/18/08 ____ 10/20/08

Personal Information:

Name (please print) _________________________________________________________

Spouse name (if spouse is also attending) _________________________________________

Address: _________________________________________________________________

City, State, Zip code: ________________________________________________________

Telephone: ___________________________ Email ________________________________

I am a: ___ parent, ___ teacher, ___ speech therapist, ___ OT, ___ PT, ___other

Please mail your registration to
Interventions Unlimited, Inc.
848 Executive Drive, Oviedo, Florida 32765
or fax the form to (407) 678-8885

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