REGISTRATION FORM

GATEWAY TO LANGUAGE AND LEARNING VIDEOCONFERENCE

10/9/02

The Arkansas Department of Education, the Easter Seals Outreach Program and David Gentry, representative of the DynaVox family of augmentative and alternative communication devices will be conducting training at the following distance learning/compressed video locations. The topic will be Gateway to Language and Learning. This is the language system used on DynaVox Systems LLC augmentative and alternative communication devices such as the DynaVox and DynaMyte 3100 series. This workshop will be repeated three times in this manner during the 2002-2003 school year. Intended participants would be school personnel working with students who use these devices. Test time will be at 8:30 a.m. and the training will be 9:00 a.m. until 12:00. Please circle the location for the date of the workshop you wish to attend and fill out the information sheet at the bottom of this registration form.

10/9/02

Arkansas River Education Service Cooperative, Pine Bluff, 870-534-6129

Dawson Educational Service Cooperative, Arkadelphia, 870-246-3077

DeQueen/Mena Educational Cooperative, Gillham, 870-386-2251

Fayetteville School District, Fayetteville, 479-973-8692

Forrest City School District, Forrest City, 870-261-1859

Northeast Arkansas Education Service Cooperative, Walnut Ridge, 870-886-7717

Southeast Arkansas Education Service Cooperative, Monticello, 870-367-6848

Southwest Arkansas Education Service Cooperative, Hope, 870-777-3076

Western Arkansas Education Service Cooperative, Branch, 479-965-2191

Name: School: Position:

Phone: E-mail: Fax:

Please return this form by mail to Easter Seals Outreach Program, 3920 Woodland Heights Road, Little Rock, Arkansas 72212, or by fax: 501-227-3771 or by e-mail to .

This activity is supported by the Arkansas Department of Education

REGISTRATION FORM

GATEWAY TO LANGUAGE AND LEARNING VIDEOCONFERENCE

1/23/03

The Arkansas Department of Education, the Easter Seals Outreach Program and David Gentry, representative of the DynaVox family of augmentative and alternative communication devices will be conducting training at the following distance learning/compressed video locations. The topic will be Gateway to Language and Learning. This is the language system used on DynaVox Systems LLC augmentative and alternative communication devices such as the DynaVox and DynaMyte 3100 series. This workshop will be repeated three times in this manner during the 2002-2003 school year. Intended participants would be school personnel working with students who use these devices. Test time will be at 8:30 a.m. and the training will be 9:00 a.m. until 12:00. Please circle the location for the date of the workshop you wish to attend and fill out the information sheet at the bottom of this registration form.

1/23/03

Arkansas River Education Service Cooperative, Pine Bluff, 870-534-6129

Dawson Educational Service Cooperative, Arkadelphia, 870-246-3077

DeQueen/Mena Educational Cooperative, Gillham, 870-386-2251

Fayetteville School District, Fayetteville, 479-973-8692

Forrest City School District, Forrest City, 870-261-1859

Northeast Arkansas Education Service Cooperative, Walnut Ridge, 870-886-7717

Southeast Arkansas Education Service Cooperative, Monticello, 870-367-6848

Southwest Arkansas Education Service Cooperative, Hope, 870-777-3076

Western Arkansas Education Service Cooperative, Branch, 479-965-2191

Name: School: Position:

Phone: E-mail: Fax:

Please return this form by mail to Easter Seals Outreach Program, 3920 Woodland Heights Road, Little Rock, Arkansas 72212, or by fax: 501-227-3771 or by e-mail to .

This activity is supported by the Arkansas Department of Education

REGISTRATION FORM

GATEWAY TO LANGUAGE AND LEARNING VIDEOCONFERENCE

2/20/03

The Arkansas Department of Education, the Easter Seals Outreach Program and David Gentry, representative of the DynaVox family of augmentative and alternative communication devices will be conducting training at the following distance learning/compressed video locations. The topic will be Gateway to Language and Learning. This is the language system used on DynaVox Systems LLC augmentative and alternative communication devices such as the DynaVox and DynaMyte 3100 series. This workshop will be repeated three times in this manner during the 2002-2003 school year. Intended participants would be school personnel working with students who use these devices. Test time will be at 8:30 a.m. and the training will be 9:00 a.m. until 12:00. Please circle the location for the date of the workshop you wish to attend and fill out the information sheet at the bottom of this registration form.

2/20/03

Arkansas River Education Service Cooperative, Pine Bluff, 870-534-6129

Dawson Educational Service Cooperative, Arkadelphia, 870-246-3077

DeQueen/Mena Educational Cooperative, Gillham, 870-386-2251

Fayetteville School District, Fayetteville, 479-973-8692

Forrest City School District, Forrest City, 870-261-1859

Northeast Arkansas Education Service Cooperative, Walnut Ridge, 870-886-7717

Southeast Arkansas Education Service Cooperative, Monticello, 870-367-6848

Southwest Arkansas Education Service Cooperative, Hope, 870-777-3076

Western Arkansas Education Service Cooperative, Branch, 479-965-2191

Name: School: Position:

Phone: E-mail: Fax:

Please return this form by mail to Easter Seals Outreach Program, 3920 Woodland Heights Road, Little Rock, Arkansas 72212, or by fax: 501-227-3771 or by e-mail to .

This activity is supported by the Arkansas Department of Education