Registration Form

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Please make a selection. * Training
(select one) Distance Practitioner Training Course
1-Day Practitioner Training Course
4-Day Advanced Training Course
The Interactive Language Program Course

* Training Session Dates & Location
[City, mm/dd/yyyy or "Distance"] Required.

My group name is (if signing up with group)

* I understand the cost of my training to be
Required.

Registration Info

* First Name Required.

* Last Name Required.

Title/Accreditation. (OT, SLP, AuD etc...)

* Profession Required.

Business Name / Employer

* Business Phone Required.

Cell Phone

* Email Valid email required.Invalid Format.

Fax

Billing Address

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Required.

* Street Required.

* City Required.

* State Required.

* Zip Required.

* Country Required.

Payment Information

Please make a selection. * Payment type (select one) Credit Card
Check

Please make checks payable to
Integrated Listening Systems
925 S. Niagara Street, Suite 660,
Denver, CO 80224

Card Type (select one) Visa
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Discover
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* First 8 Digits of Credit Card # Required.Invalid Format.

* Date of Expiration (Please use this format: mm/yyyy) Required.

* 3-4 digit security code Required.

*I authorize iLs to bill my credit card 0 for the cost of training. (Initials) Required.

Please call in to 303.741.4544 (if calling after business hours, please leave a confidential voicemail) or email office@integratedlistening.com with the last 8 digits of your CC# and to complete your registration.

Shipping Address

Same as billing address? Yes

iLs cannot ship to P.O. Boxes.

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* Country Required.

Website Listing Info

Please complete these fields as you want the information to appear on the iLs website. No, I do not want to be listed, or will request to be listed at a later time.

Name

Title/Accreditation
(OT, SLP, etc...)

Business Name

Business Address

Same as billing address? Yes

* Street Required.

* City Required.

* State Required.

* Zip Required.

* Country Required.

Website

Phone #

* Describe your professional training and work experience, including
your education, licensure and length of time in practice. Required.

* What experience with sound therapy training programs have you
had? Required.

* Please give a brief description of your existing business including
your clientele and the interventions you employ, or your potential
clientele and the interventions you will employ. Required.

* Where/From whom did you hear of iLs? Required.

* If you have previous iLs training please let us know which course,
when and where. (Year, Location) Required.

* iLs strives to provide a successful learning experience for all
learners. Please let us know if you have any special requests.
Required.

* To prove that you are a real person, please type the answer
   to the following question in the field below. What color is the sky?
   (Answer: blue)
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* I understand that my registration is not yet complete. To complete the registration process I will call 303.741.4544 and leave the last 8 digits of my credit card on the secure voice mail, or email office@integratedlistening.com with the last 8 digits. Only after all information has been submitted will my card be charged. Required.

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iLs trainee information is kept strictly confidential. Please email info@integratedlistening.com if at any time you prefer not to receive periodic updates by email on our trainings and equipment.

Registration Info

Billing Address

Payment Information

Shipping Address

Website Listing Info

Business Address

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