Registration Form - DOING THERAPY IN A POLARIZED WORLD 5/21/24

Tuesday, May 21, 2024
9:00am-12:00pm EST
$65/person (includes CE credit) - 3.0 Contact Hours
Live online webinar via Zoom

DOING THERAPY IN A POLARIZED WORLD

Presenter: William Doherty, Ph.D.

CONTACT INFORMATION

First Name *

Last Name *

Organization

Mailing Address *

City *

State *

Postal Code *

Contact Phone *

Email Address *

In order to receive your attendace and/or continuing education certificate, you will be required to submit a training evaluation form online. A link to a training evaluation form will be provided to you on the day of the training.

New York Social Workers, Creative Art Therapists, Mental Health Counselors, and Marriage & Family Therapists

New York requires a license number on the continuing education certificate for the following disciplines. Please indicate if you hold any of the following NEW YORK state licenses/certifications:

If applicable, lease provide your NY state license number (for CE certificate purposes; if you have a PA-issued license, you do not need to submit your license number)

For Pennsylvania State Board of Social Workers, Marriage and Family Therapists and Professional Counselors

Pennsylvania State Board of Social Workers, Marriage and Family Therapists and Professional Counselors
The State Board of Social Workers, Marriage and Family Therapists and Professional Counselors recognizes Family Service Society (as a sponsor approved by the National Board of Certified Counselors NBCC - #5930), to be a pre-approved provider of continuing education programs for Social Workers (Sec. 47.36), Marriage and Family Therapist (Sec. 48.36), and Professional Counselors (Section 49.36).

NBCC

Do you need NBCC CE credit? Family Service Society, Inc. has been approved by NBCC as an Approved Continuing Education Provider, ACEP #5930. Programs that do not qualify for NBCC credit are clearly identified. Family Service Society, Inc. is solely responsible for all aspects of the programs. *

Yes, I need NBCC CE credit

No, I do NOT need NBCC credit

PAYMENT

Please select the webinar(s) you are registering for: *

Tuesday, 5/21/24 - $65 (William Doherty)

Payment Method - We accept online credit card payments, checks, and purchase orders. *

Credit Card

Check (made payable to FSS PTI - mail to FSS, 280 Princeton Ave. Ext., Corning, NY) **When you submit this form you will be directed to PayPal - just exit out of it**

Purchase Order (please email the PO to orfanidesj@familyservicesociety.org. **When you submit this form you will be directed to PayPal - just exit out of it**

Other (agency partnership package, etc.) **When you submit this form you will be directed to PayPal - just exit out of it**

You will be directed to Paypal where you may enter your credit card information. Please Note: You DO NOT need a Paypal account in order to pay by credit card.

Description Text

Cancellation Policy: Refunds will be given up until seven (7) days before each training offering. You must make your refund request in writing via email to Janalee Orfanides at orfanidesj@familyservicesociety.org. REFUND REQUESTS MADE BY PHONE WILL NOT BE ACCEPTED. IT MUST BE IN WRITING/EMAIL. PLEASE NOTE THAT ALL REFUNDS MADE AT ANY TIME WILL INCUR A $5 CANCELLATION FEE. Yes, I have read and understand the cancellation policy. *

Yes

Confirmation/Questions

A confirmation/reminder email (if applicable, a link to the Zoom session) will be sent to you

before the selected training date.

Please remember, if applicable, that Zoom access for this training is only for the person named in this registration.

You may not share the Zoom link with anyone else.

Questions?

Please contact Janalee Orfanides, Director of Communications and the Professional Institute, at orfanidesj@familyservicesociety.org

Comments/Questions/Additional Information