Course Registration

SPEAK OUT!^® & LOUD Crowd^® Training
Course Registration

Contact Information

I am an SLP.

I am an SLPA.

I am an SLP Graduate Student.

I have read the SPEAK OUT! License Agreement and agree to its terms.

I understand this course must be completed in 30 days.

I understand the course registration fee and products purchased are non-refundable.

How did you hear about Parkinson Voice Project?

What % of your caseload includes people diagnosed with Parkinson's?

First Name*

Last Name*

Do you want us to report CEUs to ASHA?*

Yes

ASHA # (enter N/A if not applicable)

Name of Clinic or University*

For UK customers only, reverse charge: customer to account for VAT to HMRC.
Enter VAT number or type exempt:

Projected Graduation Date

Best Email (if we need to contact you about shipping)*

Password*

Confirm Password*

Purchase SPEAK OUT! and Loud Crowd Workbooks

All International Orders Include a $100 Shipping & Handling Fee.
Products will be shipped 2-3 weeks after completing SPEAK OUT & LOUD Crowd training.

Add a SPEAK OUT! Workbook for $ (Only sold with course registration).

Add Therapy Flashcards for $. This is 25% off the regular price.
English ONLY.

A combination of 216 photo, word, math, and conversation flash cards.

Add an Out & About LOUD Crowd Workbook for $. This is 25% off the regular price.
English ONLY.

This workbook consists of 20 SPEAK OUT! lessons with reading and cognitive exercises based on places people visit frequently (e.g. grocery store, movies, bank, airport, pharmacy, restaurant, and zoo).

Add a U.S.A. LOUD Crowd Workbook for $. This is 25% off the regular price.
(English Only)

This workbook consists of 20 SPEAK OUT! lessons with reading and cognitive exercises based on American themes (e.g. states, presidents, landmarks, famous quotes and speeches).

Only list information that NEW PATIENTS need to schedule an appointment.

Clinic Name*

First Name*

Last Name*

Credentials

Best Scheduling Telephone Number for Patients*

Website

Clinical Setting* (Shift+Click to select multiple settings)

Is your clinic facilitating a LOUD Crowd group(s)?*

Country*

Address*

City*

State*

Zip Code*

Shipping Information

Country*

Best Shipping Address*

City*

State*

Zipcode*

Best Telephone (we cannot ship if the telephone number is incorrect)*

Payment Information

Name*

Email*

Country*

Address*

City

State

Zip Code

Phone

Promo Code

Course Registration:

"Out & About" LOUD Crowd Workbook:

Flash Cards:

"U.S.A." LOUD Crowd Workbook:

A Terrific Treasury of Tongue Twisters Booklet:

SPEAK OUT! Workbook:

International Shipping: (?)

Promo Code :

Total:

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