Registration Form 7.28.24
Presenter: Shatiera Amankrah, LCSW, LICSW, PMH-C
Event Timing: Sunday July 28, 2024, 8:30 AM to 3:30PM EST
Cost- $200
Payment link is shown after completion of form.  Please do not complete this form until you are ready to submit payment.
Event Address: Location would be 5 to 20 minutes within Grand Hyatt Washington DC.  Feel free to email me with specific questions.  A minimum of 10 participants must be registered by July 1, 2024.  
Contact us at 703-952-1722 or shatiera@seedsofhopecc.com

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Are you ready to submit payment for this training? If not, please do NOT complete this form until you are prepared to make payment.  Please contact me directly via email with any questions or concerns.  This form should only be completed when registering and paying for this workshop. *
First Name *
Middle Initial
Last Name *
Credentials (select all that apply) Add license number if applicable in "other" section *
Required
How did you hear about this training? If it was a Facebook Group please specify which one. *
Do you have Perinatal Mental Health Training/Experience *
Have you had any Infertility Training, please list *
Are you an NASW Member? If Yes, what is your Member number

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Do you need a certificate for PMH-C CEUs *
I understand this training will be recorded and used for marketing purposes *
Required
Would you be interested in 6 free group consultation meetings? They would be held once per month on a Friday.  *
I understand a minimum of 10 participants must be registered by June 1, 2024.  If the training is cancelled due to participation issues, you will receive a full refund to your original form of payment.  *
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