Coastal Education Services
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A Neurodevelopmental and Neurodiversity-Informed Approach to
Supporting Children and Adolescents on the Autism Spectrum:
​Using DIR Floortime® to Promote Development

**This course also meets the prerequisite requirements for professionals
to enter the DIR Floortime® Professional Certificate Program.** 


Wed/Th.  May 17-18, 2023

Pricing

Standard Registration March 21, 2023 to May 17, 2023
$449.00/Participant for 1-4 Participants
$419.00/Participant for 5+ Participants


The Drop Down Menu at the bottom of the registration form will have the
correct pricing for the number of participants you are registering.  ​
​​

                              DIR Floortime® Registration Form  
    ​
    It is important that we have the participant's best contact information in case we need to reach them (especially outside of their business hours) for clarification and/or any last minute changes or information they may need. If other information is given we can not be responsible for lack of communication or expenses incurred as a result.

                      For a group rate to apply you must register all participants
                               on the same form and pay at the same time.   

    Please list here all the names of the people attending the conference, their credentials, and home address e.g. 1. Jane Smith, OTR/L, home address 2. Carol Summers, CCC-SLP, home address, etc.
    Please list each person's primary email address, which we will use to communicate with you. Listing a work address is not suggested as you may change this arrangement and further communication will be lost. Please number each participant and have it coincide with the number given for the name above.
    Please list each person's personal Phone # so we can contact you directly if necessary. Listing a work number is not recommended as we may need to reach you outside of work hours. Please number each participant and have it coincide with the number given for the name above.
    To complete your registration, all 5 boxes must be checked in the Terms and Agreements section. If 1 person is registering for 2 or more participants, they acknowledge that they will communicate with the others about the Terms and Agreement and are acting with permission by all listed. Each participant will receive a confirmation of their registration.
Submit

Registration Process​:
1.  Be sure to press "Submit" above to ensure we receive your registration form.​
2.  Now select your payment method below. 

Credit Card

If Paying with a credit card please use the "Buy Now" PayPal button below to select the number of participants.  Discounted Early Registration and prices for 5+ people are in the drop down menu

We use PayPal to process credit cards securely. ​
You will be redirected for the check-out process.
​

Prices have discounted rates built in for the # registered.

Checks or Purchase Orders

 ​Complete the form below if ​Paying with ​Check or a Purchase Order and follow directions to process.    
(Not necessary to complete if paying with a credit card)

    How do you plan to pay if not by credit card? 
    Checks:
    Payable to: Coastal Education Services and 
    Mail to: P.O. Box 3064, Kennebunkport, ME  04046
    Please indicate the participant the payment is for.


    Purchase Orders:  
    1.  The SENDING BUSINESS MUST INITIATE a Purchase Order.
    2.  Purchase Orders are to be email with contact information to coastaleducationservices@yahoo.com.
    3.  An invoice will be emailed to the contact person.  

    Please check if you will be sending a personal check, a business check (without a purchase order first) or a Purchase Order (requiring an invoice to be sent afterwards).
    Please list the name of the participant(s) that payment will be made for.
    Please list the name of the person that will handle the processing of the check or Purchase Order (and Invoice).
    Please list the email of the person that will handle the processing of the check or Purchase Order (and Invoice).
Submit
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