TeleTraining Registration Form

PEPNet South
is proud to host the following WebCast Opportunity:

Campus Emergency Response and the Deaf and Hard-of-Hearing Community: Bridging the Communication Gap
June 26, 2008
5:00pm - 7:30 p.m. EST

REGISTRATION DEADLINE for RID or BEI CEU's: Friday, June 20, 2008

What is a WebCast?

A webcast is a media file distributed over the Internet using streaming media technology. As a broadcast may either be live or recorded, similarly, a webcast may either be distributed live or recorded. Essentially, webcasting is "broadcasting" over the Internet. (wikipedia, 2008)

* First Name:
* Last Name:
Position/Title:
Institution/Agency:
Address:
City:
* State:
Zip:
* E-mail Address:	Tmail and Yahoo email accounts frequently bounce attachments. In order to receive information about CEUs and the teletraining you will need to provide an email address other than Tmail or Yahoo.
Phone Number:	Type of Phone: Voice TTY Both

Are you requesting RID CEUs? Yes No
If yes what is your RID number?

Are you requesting BEI CEUs? Yes No
If yes what are the last 4 digits of your Social Security number?

If you do not want RID/BEI CEUs, would you like a certificate of participation? Yes No

Select the title that best describes your role.

Disability Service Coordinator/Advisor	Student
Deaf Adult	Interpreter Coordinator
Parent of a Deaf or Hard of Hearing Child	Interpreter/Transliterator
State Director of Special Education	Speech-to-Text Coordinator
K-12 Administrator	Speech-to-Text Provider
Postsecondary Administrator	Notetaker
Director of Disability Services Office	Rehabilitation Professional
Teacher of the Deaf	Transition Coordinator
Teacher: Special Education	Audiologist
Teacher: Elementary	Speech Pathologist
Teacher: Secondary	Counselor
Teacher: Postsecondary	Psychologist
Other
If other please specify:

What do you hope to learn from this tele-training?:

Have you participated in a training seminar via teleconferencing previously? Yes No

Please add me to the PEPNet mailing list. Yes No

* = required field

If you have any questions about PEPNet, Please email us: pepnet@pepnet.org.

TeleTraining Registration Form

PEPNet South is proud to host the following WebCast Opportunity:

Campus Emergency Response and the Deaf and Hard-of-Hearing Community: Bridging the Communication Gap June 26, 2008 5:00pm - 7:30 p.m. EST

PEPNet South
is proud to host the following WebCast Opportunity:

Campus Emergency Response and the Deaf and Hard-of-Hearing Community: Bridging the Communication Gap
June 26, 2008
5:00pm - 7:30 p.m. EST