Be The Voice - Request an SLP Kit

First Name *

Last Name *

Kits are shipped for FREE to residents in the U.S. & Canada.

For residents outside the U.S. or Canada, an Apraxia Kids staff member will be in touch about different shipping and digital options regarding your request.

Address *

Address

City

State/Province

Zip/Postal

Country

Is this a business or residential address?

Business

Residential

Phone *

Email *

Are you new to the Apraxia Kids organization? *

Yes

No

How would you describe yourself? *

How best would you describe your community? *

Suburban

Rural

Metropolitan Area

Briefly describe your place of work as a practicing SLP. Clinic, private practice, school, hospital, other? *

Please tell us the name of your employer or workplace. *

*

I verify that I am a practicing speech language pathologist and will use the materials in the SLP Kit to share with clients.

I would like to receive email communication from Apraxia Kids.

I am interested in learning more about the Apraxia Kids SLP Directory and wish to be contacted to discuss the requirements and process.

We are excited to offer these kits free of charge to maximize awareness! Would you like to make a donation to help us offset the cost of printing and shipping?

Total

Credit Card

Be The Voice – Request an SLP Kit

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