Registration for Ethics Training

To register for this upcoming event, please complete the form below with your registration and payment information.

MHAFC Event Registration Form

REGISTRANT INFORMATION

Name: *

Title	First	Last

Company or Organization:

E-mail: *

Phone: *

Address: *

Address (Line 2):

City, State ZIP: *

Do you need help related to a disability?
If yes, please explain:

BILLING INFORMATION
Click here if billing address is the same as the address above.

Name: *

First	Last

Billing Address: *

Address (Line 2):

City, State ZIP: *

MEMBERSHIP INFORMATION (optional)
If you would like to become a MHAFC Member at this time and save on
future full day conferences, please complete the following section:

Membership Level:

Add an additional
donation to any
membership level.

Additional Donation:

$ --->

Membership Total:

EVENT REGISTRATION

Ethics Training

Presenter: Tamara Tingle, an Investigator with the State of Ohio Counselor, Social Worker, and Marriage & Family Therapist Board, will present a fun and inspiring ethics training class for social workers, counselors, psychologists, and chemical dependency counselors needing CEUs.

When: Tuesday, March 27, 2012

Time: Registration: 12:30 PM
Program begins promptly at 1:00 PM and ends at 4:00 PM

Cost: $45 if registered by March 6, 2012
$55 if registered after March 6, 2012

Parking fees are paid in the library, prior to leaving. Expect to pay approximately $3.

Refunds: NO REFUNDS will be given after March 13, 2012, but you may request a receipt for a tax-deductible donation if you cannot attend. Refunds prior to this date will be assessed a $20 processing fee. You may designate a substitute attendee.

Columbus Metropolitan Library (Main Auditorium in Lower Level)
96 South Grant Avenue
Columbus, OH 43215

Event Fee:

# of Registrants

Registration Total:

PAYMENT INFORMATION

Amount Due:

Credit Card Type:

Name on Credit Card: *

Credit Card Number: *

CVV Number: *

(last 3 digits on back of card)

Expiration Date: *

CONTINUING EDUCATION

This will fulfill the 3-hour CEU ethics requirement for mental health professionals in Ohio. Please provide your name as required for your certificate.

e.g. Jane Doe, Social Worker

Please be patient and only hit the key once,
otherwise you will be charged multiple times.

* indicates required field

Home Page | Return to Top