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Please complete the following form. All session times are Pacific Time.

Por favor, complete este formulario. Todos los horarios de las sesiones son del Pacífico.

What are the ages of your children with hearing loss? Select all that apply. / ¿Qué edades tienen sus hijos con pérdida auditiva? Seleccione todas las opciones que correspondan.

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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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Will You Join Us to Kick Off the Weekend on Friday, November 6, 2026, at 5:00 PM (PT)?

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Which sessions will you attend on Saturday, November 7? Select all that apply. ¿A qué sesiones asistirá el sábado 7 de noviembre? Seleccione todas las opciones que correspondan.

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If you are requesting AG Bell Academy LSLS continuing education credits, please enter your profession (SLP, Audiologist, DHH Specialist, AVT etc.) and your LSLS certification number. This is needed for your certificate and reporting to AG Bell Academy.

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Comments or questions:

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How many people, including yourself, will be watching Building Connections on the same device? / ¿Cuántas personas, incluyéndose usted, verán Building Connections en el mismo dispositivo?

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How did you hear about Building Connections? If someone referred you, please include their name or organization. ¿Cómo se enteró de Building Connections? Si alguien le recomendó el evento, incluya su nombre o el de la organización.

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