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Autism Spectrum Disorders Summer Institute

Autism Spectrum Disorders Summer Institute July 23rd and 24th, 2014 Hull Building, Longwood University, Farmville, VA

Registration Fee: $75.00 for one day and $150.00 for two days. (This fee includes the cost of registration, meals, outings and parking.)

Deadline to register is June 15, 2014 and payment must be received by June 20th.

To pay for the Autism Spectrum Institute, please complete this form then click on the "I Want to Pay Using My Credit Card" link below or submit all check payments to

Longwood University Office of Cashiering

201 High St

Farmville, VA 23909

*Checks must be made payable to Longwood University and a print out of this registration form MUST be submitted with the check payment*

NO refunds will be given after June 19, 2014. If you have registered and can not attend, please notify us by Wednesday, June 19 at 4:00 p.m. to cancel your registration and not be charged the registration fee.

*** For office use only: Banner Fund 11002 - E & G Deferred Revenue, Banner Account 22052 - Deferred Revenue - Education Workshops, Detail Code 1427 FRS 0-10000-2464 ***

Please note that when you click on this link you will then have to choose the Autism Institute tab before you are able to pay.

I Want to Pay Using My Credit Card.

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* 1. Please provide full name of registrant.

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* 2. Please advise if you plan to attend the institute for one day or for two.

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* 3. What is the name of the School Division or Organization of the registrant (if applicable)?

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* 4. Please name a person we can contact for questions.

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* 5. Please name the title of the Contact Person (if applicable).

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* 6. Please list the contact's mailing address.

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* 7. Please list the contact's phone number.

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* 8. Please list the contact's email address.

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