2013 CSI Registration

Registration for the 16th Annual Carolina Summer Institute In Auditory-Verbal Therapy

A complete application should include: The application below and payment. Payment must be mailed to CASTLE @ 5501 Fortunes Ridge Dr., Suite A Durham, NC 27713. Checks should be made out to UNCH /Dept of ENT. Applications will not be considered until payment is received and must be received by the deadline, even if a third party is paying.

Courses

I'd like to register as the following:

In State Residents - June 8-14 ($800)

Out-of-State Residents - June 8-14 ($1000)

First Name

Last Name

Your E-Mail Address

Phone Number

Fax Number

Address

State

City

Zip

Employer

Title

Housing

Are you interested in housing with a local CASTLE family for this event?

Yes

Scholarships

Limited scholarship money may be available courtesy of special funding. To submit a request for scholarship, please write a statement here to support your need for scholarship funds to be able to participate in this year’s Carolina Summer Institute in Auditory-Verbal Therapy.

Yes, I am applying for scholarship.

Statement of Support Please write a statement supporting your need for scholarship monies.

Statement of Intent Please write 250-500 words on why you want to attend Summer Institute.

I have read and understand the registration guidelines • The deadline for application to the Institute is Friday, March 15, 2013. Participants are encouraged to apply as early as possible to be considered • The total enrollment will be limited to 20 participants • Applicants will be notified of their acceptance into the Institute by Monday March 25, 2013 • Applications are not considered complete until payment has been received • Institute participants are responsible for their own food, parking, and lodging • Limited scholarships are available • This program is offered for 4.4 CEUs(Intermediate Level, Professional Area) • Cancellation of attendance less than 3 working days prior to the workshop will result in the participant being charged for that accommodation.

Payment

Payment has been sent

Payment will be sent by a third party

Filed under: AVT, cccdp, LSLS, Continuing Education Course, Symposium, Lecture, castle, Class, Seminar