Conferences & Training

Registration Form (Step 1)

Kidz Conference Services
300 Garden City Plaza, Suite 350
Garden City, NY 11530

First Name:
Last Name:
	If different, Name as it should appear on Certificate:
Discipline:	Guidance Counselor Teacher Teacher Aide Social Worker Speech Pathologist Licensed Psychologist School Psychologist OT PT BCBA BCaBA School Leader Level III Teaching Assistant LMHC Other Please Explain:
Email:
Phone:
License #:
Address:
City:
State:
Zip:
Employer:
Discounts:

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