Seminar Series Registration

Event Name:*

Name:*

First Last

Address:*

Street Address City State ZIP Code

Phone:*

Email:*

License Type:*

LICSW
Lic. Psychologist
LMFT
LMHC
Student or Unlicensed Professional
Other

Product:*

Entire Course (15 CEs)
Single Classes (no CEs)

Rate:*

Regular Rate
Student/Agency Clinician Rate

Dates:*

September 6 (FREE)
September 20
October 4
October 18
November 1
November 15

Dates:*

September 6 (FREE)
September 20
October 4
October 18
November 1
November 15

**Early Bird Rate Applies Until:

Special (not required):

September 6 (FREE)

Rate:*

Early Bird Rate
Regular Rate
Early Bird Student/Agency Clinician Rate
Regular Student/Agency Clinician Rate

*Who qualifies for the Student/Agency Clinician Rate?

We offer this discounted rate to enable students and clinicians working in community mental health settings on a full-time basis to be able to participate. Group practices are not eligible.

Agency or School:*

Payment Method:*

Credit Card via PayPal
Check

Join Our Mailing List:*

Yes, please!
No, thanks

Total

$0.00