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2015 AUTISM AND ARTS EDUCATION SYMPOSIUM
UNI Faculty/employee / STUDENT Registration (no meals)
DATES:
April 24, 2015, 4:00 - 8:00 PM
April 25, 2015, 8:00 AM - 5:00 PM
COST:
Free - no meals
*
Indicates required field
Name
*
First
Last
First name (to appear on badge)
*
If different than above.
Email
*
Phone Number
*
Website URL
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
UNI Department
*
Title (UNI faculty)
*
Major (UNI student)
*
Students Only: Are you volunteering at the symposium?
*
Yes
No
Role in autism or arts education (click all that apply):
*
Parent of a child with autism
Family member of someone with autism
Art educator
Art therapist
Drama educator
Drama therapist
Music educator
Music therapist
Special education teacher
Support personnel
Teaching artist
University faculty
Researcher
College student (UNI)
What is your role with autism?
Professional organization affiliations (click all that apply):
*
American Alliance for Theatre and Education
American Art Therapy Association
American Music Therapy Association
Association of Teaching Artists
Council for Exceptional Children
Educational Theatre Association
Iowa Alliance for Arts Education
National Art Education Association
National Association for Music Education
National Association of Special Education Teachers
North American Drama Therapy Association
Other
*
Certifications you currently hold:
*
Please list any certifications you currently hold:
Comments
*
PHOTO RELEASE
I give permission to the University of Northern Iowa to use, publish and copyright, in any form, all photographs (including but not limited to, stills, slides or transparencies) and video footage in official university publications, video productions, Web use or for official university purposes.
Choose One
*
Yes
No
Submit
