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SMAConference2017

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* 1. What is your connection with selective mutism?

I am a family or friend of a person with selective mutism.

I am a Treating Professional.

I have selective mutism.

Other (please specify)

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* 2. If you have a child with selective mutism, what is the age of your child?

Ages 2-5

Ages 6-10

Ages 11-14

Ages 14+

N/A

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* 3. How sure are you that you will attend this conference?

I definitely will attend.

I will probably attend.

I will probably not attend.

I will not attend.

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* 4. Will you need hotel accommodations?

Yes

No

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* 5. What topics related to selective mutism are you interested in?

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* 6. What activities or suggestions do you have for this conference?

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* 7. Please list your email address if you would like to receive further updates about this conference.