Workshop Registration - San Diego County Learning Disabilities Association

San Diego County Learning Disabilities Association
PO Box 421111, San Diego, CA 92142-1111
Tel: (858) 467-9158

Workshop Registration Form

Name:

Address:

City:

State

Zip

Email:

Day Ph: Evening Ph:

Pre-registering is required.
Registration is for an individual (Family members can attend at no extra charge).
Please make check payable to LDA and mail this form to the address above.

Parent School District
In Special Education? Yes No In process Not sure 504

1st	Child Son Daughter Age Grade In Special Ed? Yes No
	Disabilities

2nd	Child Son Daughter Age Grade In Special Ed? Yes No
	Disabilities

If attending for professional reasons, please state your profession, business or agency:

How did you hear about us?

	I'm attending School Problems Workshop on the following Dates: Part I Part II		$
	I'm attending IEP Goals Workshop on ...................		$
	I'm attending "Not Really a Bad Kid" Workshop on		$
	I'm attending IEP "Eyes" Workshop on .................		$
	Additional Donation (please enter amount):		$

	(click to update) Total Enclosed:		$

LDA San Diego is a 501(c)(3) organization: all dues/donations are tax-deductible.