Event Registration Form

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Virtual Supervision, Ethics, & Safety Planning in Telemental Health Counseling

Email *

First Name *

Last Name *

Telephone Number *

Which day will you be attending the event? *

Wednesday, March 20, 2024 (2-4pm CST)

Saturday, March 23, 2024 (8-10am CST)

Required

Check all that apply: *

LPC

ALC

LMFT

Registered Play Therapist

LCSW

LPC-S

Other:

Required

State AND License Number *

Have you completed payment via PayPal at PlaytherapyPlus?

****REGISTRATION NOT OFFICIAL UNTIL PAYPAL PAYMENT ALSO COMPLETED****

https://playtherapyplus.com/Events/

*REGISTRATION CLOSES AT midnight March 22, 2024

*COST IS $60

* ZOOM LINK WILL BE EMAILED TO YOU 1-2 DAYS PRIOR TO EVENT

*CE CERTIFICATE WILL BE EMAILED UPON COMPLETION OF THE EVALUATION ON WEBSITE

( WITHIN A WEEK FOLLOWING THE EVENT)

IF NEED ASSISTANCE CONTACT:

I LOOK FORWARD TO MEETING YOU!

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