Video Voice Guest Book

Guest Book

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Questions? Comments? Need more information?
Want a FREE Video Voice Demo Disk?

Simply fill out this form and click the "Submit" button!
(Please note: fields marked with are required to process your request.)

International Visitors: We have had had only limited success in mailing the Demonstration Program outside the U.S. and Canada. The best way to be sure you actually receive the demo is to download it from our site now.

Name (first & last):
School/Organization:
Address (line 1):
Address (line 2):
City:
State/Province:
Zip/Postal Code:
Country:
Daytime Phone Number:
Is this address your home or business?		Home Business
Email Address:

So that we can assist you better, please tell us a little about yourself.

I am a ...

Speech-Language Pathologist
Audiologist
Administrator
Teacher
Parent
Student
Other

If "Other", Please Describe ...

I work in a ... (please select all that apply)

School
University
Clinic
Hospital
Private Practice
Home
Other

If "Other", Please Describe ...

I work with these kinds of speech problems ... (please select all that apply)

All
Apraxia/Dysarthria
Articulation
Brain Injury
Cerebral Palsy
ESL
Hearing-Impaired/Deaf
Mentally Impaired
Multiple Handicaps
Neurological
Stroke
Voice

I have the following ages in my caseload ... (please select all that apply)

All
Preschool
Elementary
Mid School/Junior High
High School
Young Adult
Adult
Geriatric

Do you currently use any type of visual speech display equipment? Yes No

If so, what type?

Thank you very much for your help!

What type of computer do you have? Macintosh IBM (or compatible)

Questions or Comments?

For faster service, call 1-800-537-2182 or download the demo now!