Online Registration Form


REGISTRATIon Form - Online Workshops for 2019- 2020

Workshop Selection & Fees
Workshop Selection & Tuition *
Tuition for a single course | $80 Tuition for two online courses | $150
Name *
Address *
Registration Fee *
Phone for Roster *
Phone for Roster
Alternative Phone
Alternative Phone
LCSW, LMFT, LCAT, LPsyan, LMHC, Other(Specify)
Late Fee
if tuition received after deadline
New Student
Certificate of Completion
Check if applicable
Please select your method of payment. After you submit the form, please either call us to process your payment or fax us your credit card information to +
Payment Method *


Full refunds are available up to seven days before workshop begins. Refunds are not available after classes start. In the event the Center cancels a class, students may request a full refund.

CERTIFICATE OF COMPLETION: Participants must complete the entire workshop and complete all paperwork.