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I have a child(ren) with hearing loss ages 0-3 / Tengo un hijo (s) con perdida de audicion (nacimiento - 3 años)

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I have a child(ren) with hearing loss ages 4-7 / Tengo un hijo (s) con perdida de audicion de edad 4-7 años

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I have a child(ren) with hearing loss ages 8-10 / Tengo un hijo (s) con perdida de audicion de edad 8-10 años

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I have a child(ren) with hearing loss ages 11-14 / Tengo un hijo (s) con perdidad de audicion de edad 11-14 años

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I have a child(ren) with hearing loss ages 15+ / Tengo un hijo (s) con perdida de audicion de edad 15 +

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What are the names and ages of your child(ren) with hearing loss? Please also include hearing siblings. / Cual es el(los) nombre y edad de su hijo con perdida de audicion? Incluye su hermanos.

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What are you looking forward to with this Building Connections event? / Que esperas de este evento de creando conexiones?

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I need captioning. / Necesito subtítulos.

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I need Spanish or Mandarin Translation. / Necesito traducción al español.

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If you are an educator what is your profession? (SLP, Audiologist, DHH Specialist, AVT etc.) / Si eres educador, cual es tu profesión?

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I will attend Friday's Workshops

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I will attend Saturday's Workshops

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I will attend Sunday's Workshops

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If CEU's are offered I would like to receive them.

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LSLS Number (for LSLS Cert. AVT and AVEd.)

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Please provide a list of participants that will be attending any of the events over the weekend.

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Comments or questions:

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