NLD, Asperger's Syndrome, Autism, Social Skills, Dr. Byron Rourke @ Maple Leaf Center.Com Online Store for NLD, Asperger's, Social Skills and other related products!
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Seminar Title:
NLD: From Diagnosis Through Interventions for Home & School
Seminar Date:
10/23/06
Seminar Location:
King of Prussia, PA
Normal Registration:
Professional $149 Parent $125
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Send completed registration form, with payment to:
Maple Leaf Center
167 N. Main St.
Wallingford, VT 05773{1}