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Training Registration Form

Augmentative Communication-Vantage & Vanguard by Prentke Romich
  August 21, 2009 (see additional dates)

Please complete all of the information below.  If you have any questions regarding this training program, please contact ICAN.  This training precedes training on the Springboard Life device.  If you are attending that afternoon training too, please make sure to check below. 

First Name                            Last Name

Agency

Address

City                                        State                           Zip Code
    
Phone (000) 000-0000      Email Address
  

Check here if you need CEU's or CRC's
Please select the appropriate date of training you wish to attend.
August 21, 2009
September 25, 2009
October 23, 2009
November 20, 2009
December 18, 2009

Check here if you are also attending afternoon session on the Springboard Life Device