Enter your information to register for "Key Points in Apraxia Therapy"
Please provide accurate contact information so we can ensure you receive the requested information.
First name
*
Last name
*
Email
*
Mobile phone
*
I am a
*
Choose an option
Speech-Language Pathologist
Assistive Technology Coordinator
OT / PT
Teacher
Other
I work at a:
*
Choose a business type
School
Clinic/Hospital/Private Practice
Other
Is there an individual you are working with today who could benefit from an AAC device?
*
Yes
No
What age group do you work with? Select all that apply.
*
0-3
4-5
6-21
22+
How many individuals do you currently provide AAC services to?
*
1-10
11-20
21+
School / Company name
*
Address
*
City
*
State
*
Choose a state
I live outside of the United States
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip/Postal Code
*
SMS Checkmark - hidden
Yes
By clicking Submit, you agree to our
Privacy Policy
&
Terms of Use
Please verify that you are human
Submit
Should be Empty: