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2009 Dynamic Learning Groups
The Dynamic Learning Groups (DLGs) program is designed to help you:
• Meet new professional contacts
• Connect with others who share your interests
• Deepen and extend your learning at the Convention
• Apply what you learn to real-world situations

Please fill out this brief registration form indicating your work setting, employment function and primary professional interest. On site, you'll participate in an initial lunch meeting on Thursday and reconvene again over lunch on Saturday. Space is limited to the first 200 individuals to complete the form.

First name 
Last name 
Title 
Company Name/Affiliation 
Address 
Address 
City 
State  
Zip 
Day Time Phone 
Email 

Affiliation by Certification [REQUIRED]
   Audiologist
Speech-Language Pathologist
Dual
No Certification
What is your primary work setting? [REQUIRED]
   Pre-School
Primary School
Secondary School
College/University
Hospital
Nursing Facility
Home Health
Private SLP Office
Private Audiology Office
Private Physician Office
Other

(If other, please specify)
What is your primary employment function? [REQUIRED]
   Clinical Service Provider
Special Education Teacher
College/University Professor
Researcher
Consultant
Administrator
Chair/Dept. Head/Manager
Supervisor of Clinical Activity
Other

(If other, please specify)
Which topic is of most interest to you at the Convention? [REQUIRED]
   Please select the one topic which you are interested in learning more about or focusing on during the Convention.
Augmentative and Alternative Communication (AAC)
Autism Spectrum Disorders
Fluency
Language and Learning in School Age Children and Adolescents
Language Disorders in Adults
Language in Infants, Toddlers, and Preschoolers
Language Science
Motor Speech in Adults and Children
Speech Science
Speech Sound Disorders in Children
Swallowing and Swallowing Disorders
Voice, Resonance, and Alaryngeal Speech
Auditory Prostheses
Hearing and Balance Issues in Adults: Disorders and Assessment
Hearing and Balance Issues in Adults: Rehabilitation and Aging
Hearing Loss in Infants and Children: Disorders, Screening, and Assessment
Hearing Science
Academic and Educational Issues
Business, Management, and Professional Issues
(Central) Auditory Processing and Its Disorders
Hearing Loss in Children: Rehabilitative and Educational Issues
Issues in Culturally and Linguistically Diverse Populations
Research Issues Across the Discipline
Other

(If other, please specify)
If I am selected to participate in the Dynamic Learning Groups, I agree to attend both the Thursday 11:30am-1:00pm and Saturday 11:30am-1:00pm meetings, meet/communicate with group members at least once between Thursday and Saturday, and complete a follow-up evaluation of the program. [REQUIRED]
   Agree
Do not agree
Did you participate in the 2008 Dynamic Learning Groups program? [REQUIRED]
   Yes
No
Selections for the Dynamic Learning Groups are made on a first come first served basis. If you are not selected in the first round, do you want to be placed on a wait list? [REQUIRED]
   Yes
No
Submit and Print
   After submitting your request, you will receive a confirmation and the option to print a copy of the form for your files.

  

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