T.I.E.S. Registration Form
First Name
Last Name
Street Address
City
State
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Zip Code
Email Address
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School District
Name of School
Grade Level
Job
DHH Teacher
Regular Ed. Teacher
S/L Pathologist
Audiologist
Other
Credentials Held
DHH
Single Subject
Multiple Subject
Special Ed.
Emergency Permit
Other
A real-time captionist will be provided for all access needs.
If you have a hearing loss and need a real-time captionist, please indicate below.
Yes
No
Did you receive your Preliminary Credential before or after attending TIES for the first time?
Before
After
How many years have you attended TIES?
0
1
2
3
4
5
6
Which workshops do you plan to attend?
NOV 18: OBJECTIVE ASSESSMENT OF HEARING IN CHILDREN: IMPLEMENTING THIS INFORMATION
DEC 9: Device Fitting: Partnering with Your Audiologist
JAN 19: Soda Bottles and Submarines: Essentials of Speech Acoustics
FEB 17: Technology & Listening 

MAR 24: AVEd Strategies: Real Teachers in Real Classrooms

MAY 5: No Hablo Ingles..Now What?: Coaching Parents in Bilingual Language Development
I am interested in obtaining CEUs through the A.G. Bell Academy for Listening and Spoken Language.
ONLINE PAYMENT
Please fill out this section if you wish to pay online through Google Checkout's secure payment website
If you pay at the door, the price is $60/workshop
# of workshops
$50 each: Advance payment (at least one week prior to workshop), $50 per workshop
Package of 6 workshops
$240: All 6 workshops at $40 each
# of Workshops for LSLS CEUs credit through AG Bell Academy
$5: LSLS CEUs credit through AGBell Academy, $5 per workshop
FINAL STEP
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