Registration Form
Information Processing & Emotional Regulation:
Presented by PACE Place, Advance Therapy & ConnectorRxTM
For details, click on Emotional Regulation Strategies for Parents - Lino Lakes, MN.
The free Seminar is Monday, February 22nd, 2010 in Lino Lakes, MN. Dr. Calouri, Ph.D. and Eric Hamblen will present information on how an individual's ability to process information using specific areas of the brain impacts emotional regulation and the ability to learn. They will also describe and demonstrate the ConnectorRxTM and discuss strategies that can be used at home, in the school, and in the community, helping the child gain competence in all environments. The seminar will be held at: Advance Therapy 6776 Lake Drive, Suite 220 Lino Lakes, MN 55014 Registration will be completed by phone with Deb Crowell after receipt of this online notification
The free Seminar is Monday, February 22nd, 2010 in Lino Lakes, MN. Dr. Calouri, Ph.D. and Eric Hamblen will present information on how an individual's ability to process information using specific areas of the brain impacts emotional regulation and the ability to learn.
They will also describe and demonstrate the ConnectorRxTM and discuss strategies that can be used at home, in the school, and in the community, helping the child gain competence in all environments. The seminar will be held at: Advance Therapy 6776 Lake Drive, Suite 220 Lino Lakes, MN 55014
Registration will be completed by phone with Deb Crowell after
receipt of this online notification
Step 1: Registrant Information
Registrant #1 Information
(*required for confirmation)
*First Name
*Last Name
*Phone Number: Home
Phone Number: Cell
*E-Mail
*Mailing Address
*City *State *ZIP
Registrant #2 Information
(*required for confirmation of Registrant #2)
If different from Registrant #1: Mailing Address
City State ZIP
Step 2: Registrant Profile
(optional)
Please tell us a little about you or your family so that we can make the seminar as effective for you as possible. 1. About you
Parent
Professional (please describe)
Both
2. For those with special needs children, please give the name(s), age(s) and diagnosis.
Name Age Diagnosis
Please also list any siblings name(s) and age(s).
Name Age
3. About your child(ren) at home or you work with (please check all that apply)
1-3 M F
4-6 M F
7-10 M F
11-18 M F
4. Are you attending this conference with:
Spouse
Alone
Other
5. Have you attended a PACE Game Day or Seminar Series in the past?
Yes
No
Note: If you are sent to an error page, check to be sure the required fields and options have been filled out.
The required fields are:
Registration Information: First and Last Name, Home Phone, email and
mailing address.
Only the First Registrant is required.
Click to complete your registration!
Please call Deb Crowell, Office Manager at 503-356-8334 x 6# if you have any further questions about the seminar on Emotional Regulation: Strategies for Parents & Professionals or about PACE Place, Inc.
PACE Place, Inc.
2360SW 170thAve Beaverton, OR 97006
Phone: (503) 356-8334