ASSUMPTION COLLEGE
ASSUMPTION COLLEGE
AARON T. BECK INSTITUTE FOR COGNITIVE STUDIES
Workshop Registration Form
First Name: _______________________________________________________________
Last Name:________________________________________________________________
Profession:______________________________ Prof. Lic#____________________
Address:__________________________________________________________________
City:___________________________________ State:_______ Zip:_________________
Daytime Phone ( ) _________________________________________________
E-Mail Address __________________________________________________________
EVENT
I wish to register for:
______ Friday, May 17, 2019 / 8:30 am – 4:00 pm / La Maison Francaise / Salon,
Assumption College campus / Cost: $145.00
“Cognitive Behavioral Case Formulation and Treatment Planning for Substance Use Disorders”
CEUs
Licensed Mental Health Counselors: Assumption College is recognized by the National Board of Certified Counselors to offer continuing education units for LMHCs. We adhere to NBCC Continuing Education Guidelines: Provider Number 4009.
Social Workers: Application has been made to the MA chapter of NASW for CEU'S
I wish to receive CEUs for:
____ "Cognitive Behavioral Case Formulation and Treatment Planning for Substance Use Disorders" - 6 CEUs
PAYMENT
• Make $145.00 check payable to: Assumption College and return to: Sue Volungis, Psychology Department, Assumption College, 500 Salisbury Street. Worcester, MA 01609-1296
• Registration may be faxed to (508) 767-7263 and payment made at the door. Please call (508) 767-7390 for further information.
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