Opioid Addiction Counseling Competencies Registration
Register for 1, 2, 3 or all 4 courses and earn up to 12 CEHs FREE

You may select Synchronous (Live/Virtual) or Asynchronous (OnDemand/Anytime).  But you cannot register both.

DEADLINE: Synchronous Registration: October 24, 2022 | Asynchronous Registration:  January 31, 2023.  Course materials and login information will be emailed.   
Email *
Last Name: *
First Name: *
Street Address: *
City, State *
Zip Code *
Phone #: *
Email Address *
If requesting continuing education credits, select credentialing type. *
Required
Select Synchronous (Live / Virtual) or Asynchronous (OnDemand / Anytime) format. 
DO NOT REGISTER FOR BOTH
Clear selection
Select Synchronous (Live / Virtual) or Asynchronous (OnDemand / Anytime) format. 
DO NOT REGISTER FOR BOTH
Clear selection
Select Synchronous (Live / Virtual) or Asynchronous (OnDemand / Anytime) format. 
DO NOT REGISTER FOR BOTH
Clear selection
Select Synchronous (Live / Virtual) or Asynchronous (OnDemand / Anytime) format. 
DO NOT REGISTER FOR BOTH
Clear selection
If ADA/504 Accommodations are requested, describe
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Eclectic. Report Abuse