Please provide your contact information

First Name:*		Last Name:*
Email Address:*		Agency Name:*
Phone Number:*	() -   Ext.:
Title:*	Field InstructorTask Supervisor
Will you require CEUs?*	YesNo	License # or last 4 digits of SS#
Will you be joining us for breakfast? 8:30 a.m.*   YesNo
Will you be joining us for lunch? 11:45 a.m. - 1:00 p.m.*   YesNo

You must choose at least one workshop

Please select at least one workshop
Early Bird Workshop:

8:00 - 9:30 a.m. 1.5 CEUs are available

Select Early Bird Workshop Ethics: Working with People with Cognitive Impairment

Morning Workshop:

9:45 - 11:45 a.m. 2 CEUs are available

Select Morning Workshop Social Work and Criminal Justice: The Intersection and the Opportunity

Afternoon Workshops:

1:00, 2:00 and 3:00 p.m. 1 CEU is available for each workshop.
Select up to 3 of the following afternoon workshops.

Select Workshop 1 Recognizing and Resolving Ethical Dilemmas in Suicide Prevention Field Instructors Evidence-Based Database Effective Communication Builds Effective Professional Relationships Beyond Today: Tools for Professional Transition

Select Workshop 2 Recognizing and Resolving Ethical Dilemmas in Suicide Prevention Field Instructors Evidence-Based Database Effective Communication Builds Effective Professional Relationships Beyond Today: Tools for Professional Transition

Select Workshop 3 Recognizing and Resolving Ethical Dilemmas in Suicide Prevention Field Instructors Evidence-Based Database Effective Communication Builds Effective Professional Relationships Beyond Today: Tools for Professional Transition