Arizona Total Immersion Sign Language Program
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Phone:
602-705-6560
E-mail:
officemanager@aslid.com
Welcome to the Arizona Total Immersion “Experience” registration
July 7 – 11 2012
Contact Information:
Your Name
(required)
Gender
Male
Female
Age
Address
(required)
City
(required)
State
(required)
Zip/Postal code
(required)
Home Phone
Cell Phone
Work Phone
Email
(valid email required)
Emergency Contact:
Name
(required)
Phone
(required)
Alternate Phone
Please answer the following questions:
Are you:
Deaf
HH
Hearing
Have you ever participated in a Total Immersion Program?
Yes
No
If yes, where and when?
Level of sign language experience (1=begginner 5=advanced)
1
2
3
4
5
What is your Sign Language background and years of experience?
How did you hear about AZTI?
T-shirt
Add $15 for L, XL, XXL
Quantity of Small
1
2
3
4
5
Quantity of Medium
1
2
3
4
5
Quantity of Large
1
2
3
4
5
Quantity of XL
1
2
3
4
5
Quantity of XXL
1
2
3
4
5
Payment Method
Deposit of $100 is required to reserve a slot. Full payment due no later than June 7th 2012.
Payment method
Check
Paypal
CEU's
Arizona Registry of Interpreters for the Deaf (AZRID) members will be charged a $25.00 fee and non-members will be charged $40.00. AZTI has no profit in these fee’s.
Will you be wanting CEU's from RID?
Yes
No
Payment
Registration = $649 until 4/30/2012 and $675 after 5/1/2012
Paypal processing fee = $20
Purchase of T-Shirt = # of shirts x price ($10 for S, M and $15 for L, XL, XXL)
RID CEU's for AZRID members = $25
RID CEU's for non-members of AZRID = $40
I have read the FAQ page of this website and understand I will not receive anything in the mail. I do understand that I will only receive an e-mail confirming my registration from the registrar.
Link to FAQ
I agree
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