USE BROWSER PRINT COMMAND OR CLICK HERE TO PRINT FORM

Tuition
APA or State Association Member $220
Non-Association Member $275

Workshops will be limited to 16 participants. Each workshop will be filled in the order Registration Forms are received. Please indicate date(s) of your workshop preferences:

First Choice:______________________________________

Second Choice:______________________________________

Third Choice:______________________________________

REGISTRATION

Name:________________________________________________

Title:_______________ License #:_________________________

Address:______________________________________________

City:__________________ State:___________ Zip:____________

E-Mail Address:_________________________________________

Daytime Phone:______________________ Fax:_______________

APA or State Association Member Number:____________________

Please enclose check payable to Disability Reporting Services, Inc. for the applicable amount and mail to:

Disability Reporting Services, Inc.
2980 S. Rainbow Blvd, #200A
Las Vegas, NV 89146

You will be notified as soon as your registration form has been received and workshop date confirmed. If we cannot satisfy your choice preferences, your check will be returned.