E.I. Coaching Sign-Up Form For detailed information – please return HERE Subscription includes: 1. At least once monthly live zoom events (90 minutes long) with discussions, coaching examples, coach2coach practice, and featured guests (rotating home-visitors and families). We are grateful to the Infant Development Association of CA (503c nonprofit) for hosting these events! 2. Access to video webinars, handouts, and a library of parent practice videos 3. Opportunities for ongoing interaction/discussion in our private facebook group and during Peer2Peer events 4. Monthly email updates & resources 5. Full access to video webinars, which would normally cost $35+ each 6. Discounts on Stacey's other events and coach2coach practiceFull Name* First Last Email*PLEASE USE AN EMAIL ADDRESS THAT IS ASSOCIATIED WITH A GOOGLE OR GMAIL ACCOUNT. This will give you greater access to our resources (many videos are securely housed in our google site for child/family privacy confidentiality). How did you hear about us?*Social MediaInfant Development AssociationASHA or CSUEBFriend or FamilySearch EngineOtherAre you a member of the Infant Development Association of CA?*YesNoI am a:*Early Education Teacher/SpecialistSpeech-Language PathologistOccupational TherapistPhysical TherapistStudentOtherI would best describe my EI coaching & RBI as?*Somewhat familiar and comfortable, with room to growHighly knowledgeable and experiencedNew and inexperiencedWhat would you like to gain out of this subscriptionWhere do you currently work (city, state, or zip code)?*Terms and Condition* I agree to the terms and conditionPrivacy Policy* I agree to the privacy policyPlease sign below. Your digital signature indicates that your answers on this form are true and valid. By signing below, you understand that you are signing up for a group subscription (described above) and opting into email updates. Your subscription will not be renewed automatically.*Today's Date:* Date Format: MM slash DD slash YYYY Subscription Type*SLP with ASHA CEUSRegularADD ASHA CEUs to my current subscriptionStudentIDA MembersGroups of 5+2020 Freebie - Free subscription through Dec. 31, 2020 with qualifying coupon codeStudent - This pricing is reserved for college students who can confirm their student status. This subscription will expire after SIX months from the purchase date.IDA Member - This pricing is reserved for members of the Infant Development Association of CA (CA). IDA membership status may be confirmed. This subscription will expire after SIX months from the purchase date.Regular Subscription - this subscription is appropriate for most EI professionals. This subscription will expire after SIX months from the purchase date.Groups of 5 or more - Must order at least 5 at a time to qualify for this pricing. Group subscriptions will expire after SIX months from the purchase date. Please send an email if you would like to subscribe a large group (of 20+ professionals). SLP seeking ASHA CEUs - If you are an SLP, your participation is awarded ASHA CEUs through a cooperative agreement with CA State University East Bay. These CEUs are reported on your ASHA registry after completion of a learning assessment. If you do not need/want ASHA CEUs, please register as "Regular" subscriber for lower pricing. Up to 9 hours of professional development are available. This subscription will expire after SIX months from the purchase dateADD ASHA CEUS to a current subscriptionTHIS OPTION IS ONLY AVAILABLE TO SLPs. 4.5-9 hours available (0.45-0.9 CE units)Quantity*Please enter a number from 1 to 9999.99.Coupon Your ASHA # is required if you are subscribing for ASHA CEUs Total $0.00 Subscription includes: 1. At least once monthly live zoom events (90 minutes long) with discussions, coaching examples, coach2coach practice, and featured guests (rotating home-visitors and families). We are grateful to the Infant Development Association of CA (503c nonprofit) for hosting these events! 2. Access to video webinars, handouts, and a library of parent practice videos 3. Opportunities for ongoing interaction/discussion in our private facebook group and during Peer2Peer events 4. Monthly email updates & resources 5. Full access to video webinars, which would normally cost $35+ each 6. Discounts on Stacey's other events and coach2coach practiceFull Name* First Last Email*PLEASE USE AN EMAIL ADDRESS THAT IS ASSOCIATIED WITH A GOOGLE OR GMAIL ACCOUNT. This will give you greater access to our resources (many videos are securely housed in our google site for child/family privacy confidentiality). How did you hear about us?*Social MediaInfant Development AssociationASHA or CSUEBFriend or FamilySearch EngineOtherAre you a member of the Infant Development Association of CA?*YesNoI am a:*Early Education Teacher/SpecialistSpeech-Language PathologistOccupational TherapistPhysical TherapistStudentOtherI would best describe my EI coaching & RBI as?*Somewhat familiar and comfortable, with room to growHighly knowledgeable and experiencedNew and inexperiencedWhat would you like to gain out of this subscriptionWhere do you currently work (city, state, or zip code)?*Terms and Condition* I agree to the terms and conditionPrivacy Policy* I agree to the privacy policyPlease sign below. Your digital signature indicates that your answers on this form are true and valid. By signing below, you understand that you are signing up for a group subscription (described above) and opting into email updates. Your subscription will not be renewed automatically.*Today's Date:* Date Format: MM slash DD slash YYYY Subscription Type*SLP with ASHA CEUSRegularADD ASHA CEUs to my current subscriptionStudentIDA MembersGroups of 5+2020 Freebie - Free subscription through Dec. 31, 2020 with qualifying coupon codeStudent - This pricing is reserved for college students who can confirm their student status. This subscription will expire after SIX months from the purchase date.IDA Member - This pricing is reserved for members of the Infant Development Association of CA (CA). IDA membership status may be confirmed. This subscription will expire after SIX months from the purchase date.Regular Subscription - this subscription is appropriate for most EI professionals. This subscription will expire after SIX months from the purchase date.Groups of 5 or more - Must order at least 5 at a time to qualify for this pricing. Group subscriptions will expire after SIX months from the purchase date. Please send an email if you would like to subscribe a large group (of 20+ professionals). SLP seeking ASHA CEUs - If you are an SLP, your participation is awarded ASHA CEUs through a cooperative agreement with CA State University East Bay. These CEUs are reported on your ASHA registry after completion of a learning assessment. If you do not need/want ASHA CEUs, please register as "Regular" subscriber for lower pricing. Up to 9 hours of professional development are available. This subscription will expire after SIX months from the purchase dateADD ASHA CEUS to a current subscriptionTHIS OPTION IS ONLY AVAILABLE TO SLPs. 4.5-9 hours available (0.45-0.9 CE units)Quantity*Please enter a number from 1 to 9999.99.Coupon Your ASHA # is required if you are subscribing for ASHA CEUs Total $0.00 Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Pinterest (Opens in new window)Click to email this to a friend (Opens in new window)Like this:Like Loading...
