Autism The Musical Survey

Join us for a screening of this uplifting documentary as we explore the strategies implemented to develop social skills in children with autism.

Thursday, April 15, 2010
10:00 a.m. - 12:00 p.m.
Parent Resource Center
2334 Gallows Rd.
Room 224
Dunn Loring, VA 22027

Contact the Parent Resource Center with questions at 703-204-3941.

*
1. Name

Name

*
2. phone number

phone number

*
3. e-mail address

e-mail address

4. How did you hear about this workshop?

	Please check answer
PRC web site	*How did you hear about this workshop? PRC web site Please check answer
Keep In Touch e-mail	Keep In Touch e-mail Please check answer
Flyer sent home	Flyer sent home Please check answer
Parent group	Parent group Please check answer
Listserv	Listserv Please check answer

Other (please specify)

5. Accommodations and interpreters are available for workshops.
Please let us know two weeks in advance if you need any of
these services or contact the PRC at 703-204-3941.

	Yes	No
Do you need accommodations to attend this workshop?	*Accommodations and interpreters are available for workshops. Please let us know two weeks in advance if you need any of these services or contact the PRC at 703-204-3941. Do you need accommodations to attend this workshop? Yes	Do you need accommodations to attend this workshop? No

Please provide a short description of required needs.

6. Additional Participants:

If you are registering for multiple participants,
please include the total number attending.

Additional Participants: If you are registering for multiple participants, please include the total number attending. 1

Autism The Musical
Exit this survey

1. Autism: The Musical

*
1. Name

*
2. phone number

*
3. e-mail address

4. How did you hear about this workshop?

5. Accommodations and interpreters are available for workshops.
Please let us know two weeks in advance if you need any of
these services or contact the PRC at 703-204-3941.

6. Additional Participants:

If you are registering for multiple participants,
please include the total number attending.

Autism The MusicalExit this survey

1. Autism: The Musical

*1. Name

*2. phone number

*3. e-mail address

4. How did you hear about this workshop?

5. Accommodations and interpreters are available for workshops. Please let us know two weeks in advance if you need any of these services or contact the PRC at 703-204-3941.

6. Additional Participants:If you are registering for multiple participants, please include the total number attending.

Autism The Musical
Exit this survey

*
1. Name

*
2. phone number

*
3. e-mail address

5. Accommodations and interpreters are available for workshops.
Please let us know two weeks in advance if you need any of
these services or contact the PRC at 703-204-3941.

6. Additional Participants:

If you are registering for multiple participants,
please include the total number attending.