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Counseling Workshops Registration Form


First Name
Last Name
Address
City
State
Zip
E-mail
Name of your organization
License Type
License Number
Phone (###-###-####)
Home Work Cell

Course Name Cost Date
Social Media and Its Impact
$75
2/12/2016

National Counselor Examination (NCE) Test Prep Workshop
$150
2/26/2016

Trichotillomania and Other Body Focused Repetitive Disorders
$75
3/4/2016

Practical Therapeutic Strategies You Can Use With Post Traumatic Stress Disorder Clients
$75
4/8/2016

Effective Treatment Techniques For Borderline Personality Clients
$75
4/8/2016

The Study Of Consciousness And Higher Awareness
$75
4/22/2016

Paying by: Check Credit Card

Total $

This form may also be mailed to the address below.

 

 

John Carroll University- Office of Continuing Education, 1 John Carroll Blvd.- University Heights, OH 44118  |  (216) 397-4245