Application Form for ADHD Teleclass/Podcast Instructor

Copy and paste this form into a Word document, complete and then email to Attention Deficit Disorder Resources.

Put * beside items you don't want made public
Name
Title
Address
City, State, Zip
Phone
Email
Website
Biography (not to exceed 350 words)
Title of teleclass
Paragraph describing what some will learn in class
Handout attached? Yes/No
Picture attached? Yes/No
Preferred date and time for teleclass

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