Michigan Association for Infant Mental Health
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Michigan Association for Infant Mental Health
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Event Registration
ECLS – 2019-2020 Core Competency Series
ECLS – 2019-2020 Core Competency Series
$
100.00
8 available
Name
*
First
Last
Email (you will receive a confirmation email using this entry)
*
Agency/Organization
*
Cell Phone (emergencies only)
*
Are you a Licensed Social Worker or Licensed Professional Counselor?
*
Yes
No
License Number (required for continuing education)
*
What is your level of endorsement, if applicable?
*
Infant Family Associate
Waiver
Infant Family Specialist
Infant Mental Health Specialist
Infant Mental Health Mentor
Not Applicable
Please indicate your discipline
*
BA
BS
BSN
BSW
EdD
LP
LPC
MA
MEd
MS
MSW
MSN
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PhD
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