Registration: Third Annual National Ted and Roberta Mann Foundation Symposium about Children & Young Adults with Mental Health and Learning Disabilities

Symposium Registration

Please note that registration is currently full. Filling out this form will put you on a WAITING LIST.

Fields labeled with * are required. If these fields are left blank, your registration cannot be processed.

*First name: *Last name:

*I am a (please check all that apply):

   Parent    Child's Age:    Child's Disability:
   Teacher    Grade:
   School Administrator
   Other Professional
   Education Student

Organization/Employer:

*Home Address:

*City:      *State:      *Zip:

*Summer Phone:    Fax:    *E-mail address:

(We need summer contact information to reconfirm your attendance. Thank you.)

Do you have special dietary needs?

No
Yes Please describe (if yes):

Do you need a sign language interpreter?

No
Yes

6.5 CEUs will be awarded to those attending the full day of the Symposium.

*How did you hear about the Symposium?
   Mailed Brochure
   Email from PACER
   Email from School District
   Email from Friend
   PACESETTER
   Playbill at PACER Center Benefit
   Other Organization:
   Other:

One individual per registration form submission. Group registrations are not available.

Visit PACER's other sites: National Parent Center Network (ALLIANCE) | Kids Against Bullying | Project C³ | FAPE Project | Minnesota SEACs

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Registration: Third Annual National Ted and Roberta Mann Foundation Symposium about Children & Young Adults with Mental Health and Learning Disabilities

Symposium Registration