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Registration Form

Overview of Deaf-blindness with an Emphasis in Communication Course
Registration Form

Are you a (Please check):
Parent (of a child with deaf-blindness?) Yes No

Teacher/Service Provider (of a child w/deaf-blindness?) Yes No

Other (Please describe)

Course Fee: $100
Payable to:
Project for NM Children & Youth who are Deaf-Blind

Mail check or money order to:
UNM Center for Development & Disability
Project for NM Children & Youth Who are Deaf-blind
2300 Menaul NE
Albuquerque, NM 87107

Taking class for Credit? Yes No

If yes, there is an additional fee of $165 payable to New Mexico State University. (3 credit hours -$150 plus $15 registration fee.)

For credit, you must register with the Project for NM Children & Youth who are Deaf-blind and register with NMSU. Please contact us for instructions.

Do you want a "Certificate of Completion" mailed to you once course is finished? Yes No

How did you hear about this course?

Please send completed form to:
Project for NM Children & Youth Who Are Deaf-blind
FAX: (505) 272-5280 or email to nmdb@salud.unm.edu

For questions, email nmdb@salud.unm.edu or
call Toll Free: (877) 614-4051