San Francisco Bay Area One-Day Conference

Registration Form

We kindly ask that you register as early as possible, so that we can best plan for the day. However, registration is also available on-site, on the morning of the conference. Included with your registration is a basic child-friendly lunch for all attendees. We recommend you bring your own lunch in cases of dietary needs or restrictions.

If you encounter any difficulties registering, please reach out to us at friends@friendswhostutter.org

"*" indicates required fields

Name*

First Last

Email*

Phone*

Registration:*

Families: Please select a family ticket totaling $95 for your entire family (up to 6 people).

SLPs: Earn 0.55 ASHA CEUs. SLPs must stay for the full day to earn CEUs. If you do not need CEUs, please register as an individual.

SLPs attending with a client’s family: We offer a reduced registration rate for SLPs who are attending with a family (e.g., a client or family you work with). This registration also includes 0.55 CEUs. Each person must submit an individual registration, but eligible SLPs will receive the discounted rate upon indicating the family they are registering alongside. To receive the reduced rate, please complete your own registration form and include the name of the family you are attending with in the designated section below.

Individuals: Please choose this option if you are an adult who stutters, a parent/guardian attending without your children, or an SLP who does not need CEUs.

Graduate/Undergraduate Students: Choose this registration if you are a graduate student or an undergraduate student studying speech-language pathology, whether you are volunteering at the conference or not. This registration includes lunch. (Note: If you are interested in volunteering, please email Nic Brow at nic@friendswhostutter.org)

Family: $95.00

Individual: $60.00

SLP earning CEUs: $125.00

SLP (with CEUs) attending with a client’s family: $70.00

Graduate/Undergraduate Student: $25.00

Which family did you recommend to attend this one day conference?*

Please share the family's last name. Thank you!

SLPs, please select one:*

I would like to earn ASHA CEUs. By choosing this option, I understand that my information will be sent to ASHA CE

I do not wish to earn ASHA CEUs and therefore do not want my information sent to ASHA CE

How did you hear about this conference?*

Which of the following Friends programs have you or your family attended in the past?*

Please select all that apply. This will help us plan our programming for the day.

Friends One-Day Conference

3-Day Friends Convention

Friends Virtual Groups

It's my/our first time attending any Friends program.

Billing Address (credit card)*

Street Address Address Line 2 City State ZIP Code

How many attendees are coming? Please include yourself in the total.*

Please note: All children (under the age of 18) must be accompanied by a parent or guardian. Children’s workshops are typically recommended for ages 5 and up. However, if you think your child will be unable to be in a kids workshop without a parent/caregiver, or is under age 5, we recommend arranging childcare.

Below, please specify the full names, ages (for children), and status/relationship to the person who stutters.

ex. Maria Garcia, 10, child who stutters

ex. Nick Garcia, 8, sibling

ex. Dawn Williams, parent

ex. Adam Williams, adult who stutters

Who will be attending? (Please include yourself. NOTE TO FAMILIES: Click on the plus sign to add more family members.)

First Name

Last Name

Pronouns

Age (if under 18)

Identity/Role*

Child Info**

*Identity/Role in the Stuttering Community: Please list all that apply from the following: Young person who stutters (YPWS); Adult who stutters (AWS); Parent (P); Sibling (S); Friend/Relative (F); Speech-Language Pathologist (SLP), Significant Other (SO), Graduate Student, or type in your relationship to the person who stutters, e.g., grandparent, teacher, ally, etc.

**Child info: If applicable, let us know a little about your child. Any/all information helps us better tailor our programming to their needs.

I am a/an... (please check all that apply)*

Adult who stutters

Parent or 'like a parent' to a person who stutters

SLP

Significant other to a person who stutters

Friend or relative of someone who stutters

SLP graduate student

SLP undergraduate student

Teacher

Other

Please read:*

I understand that a child-friendly lunch will be provided by Friends. In cases of dietary needs or restrictions, I understand that I need to bring my own (or my child's) lunch.

Make a small contribution to Friends

Friends is a non-profit, primarily volunteer grassroots organization that is sustained largely by the fundraising efforts of its supporters. We invite you to add an optional $5, $10, or $20 donation (or other amount) to your registration to support the Friends mission of enriching the lives of children who stutter and their families.

$10

$20

Other

Other donation amount

Would you like to pay it forward?

You can now gift Friends a donation in order to cover the cost of a family that wishes to attend a One-Day Conference but has financial constraints. If your life has been touched by Friends and you would like to see the same happen for others, this option is for you. We also welcome other donation amounts towards family registrations.

$60 - Sponsor an Individual

$95 - Sponsor a Family

Other

Other donation amount

Do you want to cover the payment transaction fees?

Yes, I would like to cover the payment transaction fees.

Transaction Fees:

Price: $0.00

Discount Code

Credit Card

Total

The total above is based on the One-Day Conference you have chosen to attend, and the type of registration.

Refund Policy: Registrations may be refunded up until 24 hours prior to the conference. Please send an email to nic@friendswhostutter.org to initiate a refund.

PLEASE NOTE: By entering and attending this event, you acknowledge and agree that your likeness may be included in photos and videos of the event and used by Friends to illustrate and promote Friends and its programs. For questions or concerns, please contact friends@friendswhostutter.org

Phone

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San Francisco Bay Area One-Day Conference

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