Professional Registration

I Would Like To Register as a Professional and Receive Professional Credit For This Session!
Cost for Professionals Seeking CE Credit: $60/session or $150 for all 3 sessions

Name (first):
Name (last):

Email:

Phone:

Address:

City,
State:
Zip:

	I would like to attend: (select all that apply)
	Session 2: February 6, 2010: Teaching Alternative Ways of Behaving
	Session 3: April 24, 2010: Developing a Social/Emotional Plan for Individuals with Autism Spectrum Disorder

Guests:	(including yourself)
Guest Names:



I am a:
	Professional Affliation:
	Louisiana State Board of Medical Examiners for Occupational Therapy
	Louisiana State Board of Physical Therapy Examiners
	Louisiana Board of Examiners for Speech Pathology and Audiology
	Other
If other:

License #:
	NOTE: Continuing Education Hours (3) have been approved by the Louisiana Board of Physical Therapy Examiners and the Louisiana Board for Speech Pathology and Audiology. An application for 3 continuing education hours has been submitted to the Louisiana Board of Medical Examiners for Occupational Therapy; we are awaiting their response. If you have questions regarding the approval, please contact Leigh Anne Baker at 225-610-8770 or at leighannebaker@hotmail.com.
	$60/session or $150 for all 3 sessions
	Professional Continuing Education Credit will only be given to those registering as a professional. Registration is not complete until your check is received by the Junior League of Baton Rouge. YOUR CHECK IS YOUR RSVP! Professional Continuing Education Credit will only be given to those registering as a professional. Registration is not complete until your check is received by the Junior League of Baton Rouge. Send your check payable to the Junior League of Baton Rouge to confirm your registration: Junior League of Baton Rouge c/o Leigh Anne Baker 9523 Fenway Ave Baton Rouge, LA 70809-1411 NOTICE OF PROFESSIONAL ONLY FORUM: All professionals who register for the Baton Rouge Speaker Series seminar on April 24, 2010, are invited to attend a professional forum with Denise Sawan Caruso. Date: April 24, 2010 Who: Professionals Who Attend Any of the Baton Rouge Speaker Series Sessions Location: Baton Rouge Speech & Hearing Foundation, 535 Roosevelt Street, Baton Rouge, LA 70802 Time: 1:30-3:30 p.m. Cost: Complimentary
	Yes, I will attend the Professional Forum


	IMPORTANT REMINDER REGARDING CHILDCARE: Please be advised that there will be NO CHILDCARE provided at this event and therefore adults only attendance is required at this event. .

Baton Rouge Speech and Hearing Foundation

Professional Registration