Registration Form - Wednesday, May 31, 2023 - PLAY THERAPY WITH SEXUALLY TRAUMATIZED CHILDREN

Wednesday, May 31, 2023
PLAY THERAPY WITH SEXUALLY TRAUMATIZED CHILDREN
Presenter: Jodi Ann Mullen, PhD LMHC NCC RPT-S CCPT-S
9:00am - 4:00pm; Clarion Inn (formerly the Holiday Inn) - Elmira, NY
6.0 Contact Hours - $149/person (includes all-day coffee bar & lunch)

THIS IS AN IN-PERSON TRAINING EVENT.

There is ample, free parking available at the Clarion Inn.

SEATING IS LIMITED FOR THIS EVENT

CONTACT INFORMATION

First Name *

Last Name *

Organization

Mailing Address *

City *

State *

Postal Code *

Contact Phone: *

Email Address *

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 training you are registering for: *

Wednesday, May 31, 2023 - $149 (Dr. Jodi Ann Mullen)

Payment Method - Please indicate your payment method below. FULL PAYMENT MUST BE RECEIVED PRIOR TO THE TRAINING ON MAY 31st. OR WE MUST RECEIVE A FULLY COMPLETED PURCHASE ORDER. Questions? Please call Janalee Orfanides at 607-542-5330 (Cell Phone). *

Credit Card

Check

Purchase Order

Other Other

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.

Cancellation Policy: Refunds will be given up until May 24th at midnight (EST). You must make your refund request via email ONLY to Janalee Orfanides at orfanidesj@familyservicesociety.org.

No refund requests will be accepted after May 24th at midnight. However, you will be allowed to substitute another person. PLEASE NOTE THAT ALL REFUNDS - made at any time - WILL INCUR A $5 CANCELLATION FEE.

I have read and understand the cancellation policy. *

Yes

Confirmation/Questions

A confirmation/reminder email will be sent to you approximately 10-14 days before the training event.

Questions?

Please contact Janalee Orfanides, Director of Communications & the Professional Training Institute, at orfanidesj@familyservicesociety.org. You may also reach out to her at 607-542-5330 (Cell Phone).

Comments/Questions/Additional Information