Register Online

Registration Form

*Name:
*Address:
*City:		*State:	*Zip:
Home Phone:		Cell Phone:	Work Phone:
*Email:
Are you a teacher or other autism professional ?			Yes No
Name of employer:
*Date of desired workshop/event:		Workshop Listing
*How many people are attending?
*How did you hear about our workshop/event?

Please specify friend/event/media/other:
	Workshop fees can be paid by mailed or at the door by cash, check or money order. Purchase orders may be sent via mail, fax (216-464-7602) or email attachment. Check the workshop listing for fees.

Milestones Organization • 23880 Commerece Park, Suite 2 • Beachwood • Ohio, 44122• (216) 464-7600