3rd El Paso for Autism Conference

Friday, December 4, 2026
11670 Chito Samaniego Dr. EPTX 79936
7:30 am - 3:30 pm

Exit Survey

Questions marked with a * are required

100%

Contact Information/ Información de contacto

Last Name/Apellido

Name/Nombre

Address/Dirección

City/Ciudad

Zip/Codigo Postal

Phone/Telefono

Email Address/Correo Electronico

Are you attending as a parent or family member of a child with a disability?/ ¿Asiste como padre o familiar de un niño(a) con discapacidad?

Yes/Si ($35)

Attending as a professional NO CEUs are needed ($75.00)

Professional with CEUs for SW, SLP’s, or LPC’s ($100.00)

Self-Advocate/Autodefensor ($35)

Student/ Estudiante ($35)

Presenter

How would you like to pay the registration fee?/¿Cómo desea pagar la cuota de inscripción?

Credit/Debit Card (SCAN the QR code at the end of the registration)

Check (Payable to CDIC, send it to 1200 Golden Key Cir. Ste 320, EPTX 79925, Attn: EP4Autism)

Cash/Efectivo (Call us to make arrangements)

Purchase Order (Call us to make arrangements)

Presenter

For parents or family members: Disability of your Child/ Discapacidad del niño(a)

Age Range of your child/Rango de edad del niño(a)

Race/¿Raza?

Ethnicity/Etnia

Primary spoken language?/¿Idioma principal hablado?

School District/Distrito Escolar

Comments (Need Any Accommodation?...please call us by Nov 14)/Suggestions/ Comentarios (Si necesita alguna adaptación, llámenos antes del 14 de Noviembre):

For Credit/Debit Card payments go to https://tinyurl.com/3EP4Autism-Pay or scan the QR code:

Para pagos con Tarjeta, visite https://tinyurl.com/3EP4Autism-Pay o escanee el código QR:

Thank you!

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