An Introduction to Verbal Behavior

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					                       Workshop Registration
               An Introduction to Verbal Behavior:
Using Applied Behavior Analysis to Teach Communication Skills to
    Children with Autism and other Development Disabilities
              January 17 and 18, Saturday and Sunday
                       Check in at 8:30 a.m.
                                 Donuts and Coffee provided
                          Workshop 9:00 a.m. – 4:00 p.m.
                  There will be a break for lunch from 12:00 p.m. to 1:00 p.m.

                                 2416 E Washington
                                      Suite G
                                Bloomington, IL 61704

                             Cost: $100.00 per person

                        January 17 & 18, 2009 Workshop Registration

Name: _______________________________________________________________________


Phone Number(s):______________________________________________________________

Email Address:________________________________________________________________

Amount enclosed:______________________________________________________________
Bill my Children’s Support Waiver Fund
(service contract may be need to be updated during check-in )

Print this form and mail it with your payment by January 14, 2008 to:

                                         Circles BCS
                                  2416 E Washington Suite G
                                    Bloomington, IL 61704

                                Questions? Call 309-660-1378