Gravity Form to e-signature-International Workshops (Addendum) Today's Date1112345678910111229123456789101112131415161718192021222324252627282930312023202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920ORIGINAL Contract Date(Required) MM slash DD slash YYYY Workshop Partner Full Name (First Name and Last Name)(Required) Workshop Partner Organizaton(Required) Workshop Partner email(Required) Workshop Course(Required) Level 1: Three Part Treatment Plan for OPT Level 2: OPT: Assessment and Program Plan Development Level 4 (Note: there is an addendum for this course and will be sent after this agreement is signed) Level 3 (Note: there is an addendum for this course and will be sent after this agreement is signed) Differential Diagnosis: Childhood Apraxia of Speech Feeding Therapy: A Sensory-Motor Approach Functional Assessment and Treatment of TOTs (Tethered Oral Tissues) Taking Your Client with Autism from Non-Vocal to Verbal Other Workshop Instructor(Required) Vanessa Anderson Smith Line Avers Lori Overland Monica Purdy Renee Roy Hill Rehab Zaytoun ORIGINAL Start Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202320242025ORIGINAL End Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202320242025NEW Start Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202320242025NEW End Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202320242025
