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The TIM Academy Registration Form Please enter the following information and click next. You may mail a purchase order or check to the address below or pay via Paypal on the next page: Michelle McGurl The TIM Academy 973 Old Lancaster Rd. Suite 100 Berwyn, PA 19312
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School District or Support Service Agency: (If Applicable)
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Parent or Professional :	Parent Professional

I would like to attend:
Structured Teaching I (June 23 - 27, 2008) Structured Teaching I (July - coming soon!) Structured Teaching I (August 11 - 15, 2008) Structured Teaching II / Beyond the Basics (October 15 - 17, 2008) Changing Challenging Behavior (December 11 - 12, 2008 & January 29 - 30, 2009) Structured Teaching for the Included Child (February 25 - 26, 2009) Community Based Instruction for the Child with Autism (March 26, 2009) Working collaboratively with Families Affected by Autism (April 30, 2009) Tour of the Timothy School (November 12, 2008) Tour of the Timothy School (March 18, 2009) Tour of the Timothy School (date) Tour of the Timothy School (date)

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Years of experience with children diagnosed with autism
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* If you are a professional seeking ACT 48 hours, please provide the following information:
Pennsylvania Personal ID# : OR
Date of Birth: AND Social Security Number: