ILUSATRAINING  Course Registration Form

Please fill out the form below and click SEND to register for a course

(Click here for a printable registration form to mail)

 

Name  
 
Title  
 
Agency  
 
Agency Address  
 
City  
 
State  
 
ZIP  
 
Phone  
 
E-mail  
 
Length of time in present position:   years months
 
Course you are registering for:  
 

Reason for attending this program:

  
 
Please check below to ensure proper accommodations:
 
   Wheelchair accessibility
 
   Audio Tapes
 
   Assistive Listening Device
 
   Interpreter Services - ASL
 
   Interpreter Services - Oral
 
   Interpreter Services - Deaf-Blind
 
   Large Print
 
   Braille
 
   Handouts/materials on CD
 
   Other (describe below):
 
   
 
 
Please make checks, purchase orders and vouchers payable to:
RB House Assoc.
Box 171
Getzville, NY 14226
All payments must be received prior to the registration date of the course.

     
 
 


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