LMFTs and LCSWs: This course qualifies for six (6) hours of Continuing
Education Credits for LMFTs and LCSWs. California Board of Behavioral Sciences CEU Provider # PCE 3287.
Psychologists:
This course has been submitted for MCEP continuing education for Psychologists. DaLene Forester, PhD, LMFT is approved
by the MCEP Accrediting Agency to offer mandatory continuing education for psychologists and maintains sole responsibility
for this program. Provider # FOR025.
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Return Registration form to:
AEI
P.O. Box 991962
Redding, CA 96099
or Fax to : (530) 245-9222
Name:__________________________________________________________________
(Please
print as you want your name on your Certificate of Completion)
Profession or Title: ________________________________________
Professional Lic. #_____________
Mailing Address:_______________________________________City:__________________________
State: ______ Zip: __________
Contact Phone (____)______________ E-Mail:____________________
Please enclose full payment
with registration form. Check method of payment.
__ Check for $ ________ Please make payable
to: AEI
__ Charge the amount of $__________ to my ____MasterCard ____Visa
Card Number: ________________________________________
Exp. Date: __________
(Please enter all raised numbers)
Name as it appears on Card: ________________________________________________
Signature:
______________________________________________________________
Attendance at the entire program is required for CE Credit.
No partial Credit will be awarded.
Please register
early and arrive before the scheduled start time. Space will be limited. Attendees requiring special accommodations must advise
DaLene Forester, PhD, MFT at least 15 days in advance. Registrants canceling up to 72 hours before the workshop will receive
a tuition refund less a $25.00 administrative fee. No refund for less than 72 hours cancellation. A $25.00 service charge
applies to each returned check. MasterCard and Visa accepted.