2023 Registration Form
Your Information
*
Indicates required field
Your name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Email
*
Phone number
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Emergency contact name
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First
Last
Emergency contact phone number
*
Your gender
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Female
Male
Other
If you checked 'Other', please provide details
*
Your age
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18-25
26-35
36-50
Over 50
AZTI T-Shirts
AZTI t-shirts are available in Small, Medium, Large, XL, XXL, and XXXL sizes
Cost: $30.00 + $4.00 fees (Online)
Would you like to buy 1 or more t-shirts?
*
Yes
No
Please list the number and size(s) of t-shirts you want
*
Examples: "1 medium" or "2 XL and 1 small"
Please Answer the Following Questions
What is your hearing status?
*
Deaf
Hard of Hearing
Hearing
How did you hear about AZTI?
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Have you ever attended a Total Immersion Program?
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Yes
No
If yes, when and where?
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How many times have you attended ASL AZTI?
*
Please select your signing level:
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1 Beginner: From no signs to short 1 to 2 sentences.
2 Intermediate: Between 2 to 4 sentences and between slow to moderate signing speed.
3 Advanced: Can have a casual conversation in ASL, including depictions (Classifiers), Surrogates (Role Shifting), Use of Space, and between moderate to smoothly signing speed.
4 Interpreting Practice: Advanced level, but also interested in practicing interpreting.
Optional: Additional comments regarding your signing level
*
Do you have any room accommodation requests? If so, please describe them.
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No
Yes
Examples: "First floor", "Wheelchair accessible"
Accommodation requests:
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Do you have a preferred roommate? If so, please list their name. We cannot guarantee roommate assignments.
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No
Yes
Requested roommate:
*
Would you prefer a single room? (Additional cost of $600)
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No
Yes
Do you have any dietary restrictions? If so, please describe them.
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No
Yes
Dietary restrictions:
*
Do you have other special needs? If so, describe them.
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No
Yes
Special needs:
*
Payment Method
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Check
Credit Cards - Processing fee $40.00
* 1
st
Early Bird:
$1,100.00
Postmarked by May 31, 2024
(If you made the deposit of $100.00, pay the difference of $1,000
.00 by May 31st, 2024)
* After June 1, 2024 or later
$1,165.00
* Registration is limited to 40 participants!!!! HURRY
* Credit Cards processing fee = $40.00
* NOTE: I'd strongly recommend you to mail the checks in order to avoid paying the processing fees. You can pay the balance of $1,100.00 by May 31, 2024.
*
The $100.00 registration fee to hold your spot is
nonrefundable
. If additional money has been paid and participants must cancel, contact ASL AZTI at
[email protected]
no less than 30 days prior
to the start of the retreat on July 6, 2024. No refunds for cancellation (regardless of reason) less than 30 days of the start of the retreat. However, if a participant must cancel less than 30 days prior to the start of the retreat, the participant may transfer her/his slot to someone and arrange to recoup money or the participant may donate the slot as a scholarship.
* To reserve your spot, please
pay online in our store
or mail a check to:
ASL Arizona Total Immersion
P.O. Box 12052
Tempe, AZ 85284
Email address if you have questions:
[email protected]
I have read the FAQ page of this website and understand I will not receive anything in the mail. I do understand that I will only receive an email confirming my registration from the registrar.
Confirmation
*
I agree to the above conditions
Submit
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In Loving Memory
Contact
Home
About AZTI
Philosophy and Principles
Registration
Meet Our Instructors
Testimonials
FAQ
Store
In Loving Memory
Contact
