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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