National Association of Social Workers - Pennsylvania Chapter
2017 PCB Annual Conference Lancaster, PA on May 1 - 2, 2017 These credits are for licensed social workers, licensed clinical social workers, licensed marriage & family therapists, and licensed professional counselors, as approved by NASW-PA. To obtain your CE certificate: Complete this packet, complete the evaluations, and provide payment ($15 for NASW members and $25 for non members): Mail in this packet & payment (make checks payable to NASW-PA) toNASW-PA, 1000 Bent Creek Blvd, Suite 40, Mechanicsburg, PA 17050Or… complete credit card entry below and fax to 717-697-5686or scan to anewkam.naswpa@PLEASE PRINT CLEARLY, as this name will be printed on your CE certificate which will be emailed:Name: ________________________________________________ Credentials _________________NASW Member: NOYES, Membership # (not necessary) ___________________________ Address: _______________________________________________________________City, State, Zip: _________________________________________________________Phone _____________________________________E-mail ____________________________________@ __________________________Total of ALL Workshop CE’s ________(max 12 CEs)By signing this statement, I attest to the fact I have attended all workshops evaluated within this continuing education packet in their entirety and that all of the information in this packet is accurate and correct. I take full responsibility for attending each session, completing these workshop evaluations, and submitting this packet, as outlined above. NASW-PA is neither legally liable nor responsible for the accuracy or completeness of this packet. NASW has been designated as a pre-approved provider of professional continuing education for social workers (Section 47.36), marriage & family therapists (48.36), and professional counselors (49.36) by the PA State Board of Social Workers, Marriage & Family Therapists, and Professional Counselors.Signature: _____________________________________________ Date: ____________________*************** Staff will destroy credit card information after processing payment **************Credit card # _________-___________-___________-____________Exp date: _____/_____CVV: _________Credits will be earned when the session is evaluated.Monday, May 1, 20171 CE8:00 am Keynote Address – Deb Beck, MSW Did you attend? Yes No3 CE9:30 am Session Title: _____________________________________________________EXCELLENTABOVE AVERAGEAVERAGEBELOW AVERAGEPOORCourse met my expectations:54321Instructor’s presentation style:54321Comprehensiveness of presentation:543213 CE1:30 pm Session Title: _____________________________________________________EXCELLENTABOVE AVERAGEAVERAGEBELOW AVERAGEPOORCourse met my expectations:54321Instructor’s presentation style:54321Comprehensiveness of presentation:543211 CE4:30 pm Special Panel Discussion Did you attend? Yes NoTuesday, May 2, 20171.0 CE8:00 am Keynote Address - Jean M. Bennett, PhD, MSM, MSN, RNDid you attend? Yes No3 CE9:00 am Session Title: ___________________________________________________Ethics? Y NEXCELLENTABOVE AVERAGEAVERAGEBELOW AVERAGEPOORCourse met my expectations:54321Instructor’s presentation style:54321Comprehensiveness of presentation:54321Overall thoughts on the conference:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ................
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