1
PARTICIPANTS INFORMATION
2
WORKSHOPS
3
INVOICING INFO
4
CHECKOUT/PAYMENT
REGISTRATION FORM
PARTICIPANTS INFORMATION
Title
Select
Mrs
Mr
First Name
Last Name
Email
email
Participant Type
Select
PAL/DKTD members
Non PAL members, other
Students
Specialty
Select
Child neurologist
Child psychiatrist
Ear, nose and throat expert
Education professional
Linguist
Logopedist
Neurologist
Neuropsychologist
Occupational therapist
Pediatrician
Physiotherapist
Psychologist
Social worker
Special education teacher
Speech and language therapist
Student
Voice specialist
Other
Cost: [FIELD9]
WORKSHOPS
20€ per workshop; 30€ for two workshops; 50€ for three workshops.
Select Workshop(s)
Workshop I (Şevket Özdemir, Semra Selvi Balo, Suzan Dilara Tokaç)
Workshop II (Dr. Esra Özcebe & Dr. Fatma Esen Aydınlı)
Workshop III (Giorgos Fourlas)
Cost: [FIELD58]
INVOICING INFORMATION
Name/Company Name
V.A.T
Telephone
Address
City
Zip Code
Country
State
CHECKOUT/PAYMENT
Total Cost
: [ field58 + field9 ]€
Form Submission
Terms & Conditions
I have read and accept the
Terms & Conditions
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