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Last Updated:
3/16/2020
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Registration
Name* First
Password
Email
Home address
City
State
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AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCon
Adult (18 and over)
Child (Under 18)
Person who Stutters (PWS)
Teen who Stutters
Parent of a Child who Stutters
Family member of a PWS
Other interested person
Physician
Teacher, counselor or other professional
SLP You selected SLP, would you mind being more specific?
School
Clinic
Private Practice
Clinical (University)
Professor (University)
Data Name Data Type Options
Name* First   Text Box
Password   Text Box
Email   Text Box
Home address   Text Box
City   Text Box
State   Text Box
Country   Text Box
Postcode   Text Box
  dropdown
  checklist AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCon
  checklist Adult (18 and over)
  checklist Child (Under 18)
  checklist Person who Stutters (PWS)
  checklist Teen who Stutters
  checklist Parent of a Child who Stutters
  checklist Family member of a PWS
  checklist Other interested person
  checklist Physician
  checklist Teacher, counselor or other professional
  checklist SLP You selected SLP, would you mind being more specific?
  checklist School
  checklist Clinic
  checklist Private Practice
  checklist Clinical (University)
  checklist Professor (University)

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Comment by: admin
Comment on: 01/09/2020