2022 Other Trainings for Mental Health Providers–Registration Form Full Name of Person attending the training:* First Last License/Credentials* Occupation* Agency or School* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Name of Person completing this form if different from attendee First Last Email of Person Completing this form--if different from Person Attending the Training. (If you're registering more than one person--please add each person's name and email and which trainings they will be attending to the "Special Accommodations" box. Thank you. Do you have a Promo Code? Practical Legal Tips for KY Mental Health Providers October 21, 2022 (Practical Legal Tips) 6 Hour Class About Legal Tips for Mental Health Providers **Currently Provided via Webinar** Approved by NBCC and thus meets KY Counselor and Social Work Requirements for CE Hours. CE Approved for KY Psychologists and Marriage and Family Therapists.Trauma Informed Practice for Mental Health Professionals Working with Children and Adolescents August 26, 2022 (Trauma Informed MH for Children) 6 Hour Class Increasing Mental Health Providers knowledge of Trauma Informed Practice with Children **Currently Provided via Webinar** Approved by NBCC and thus meets KY Counselor and Social Work Requirements for CE Hours. CE Approved for KY Psychologists and Marriage and Family Therapists.Continuing Education needed (you may choose more than one): Counseling Marriage and Family Therapist Psychology Social Work N/A - I'm a Student Other FRYSC If other, please list here* Any special accommodation?Total Cost of Registration: $0.00 May we add you to our mailing list so you can be updated on other upcoming trainings and happenings at Brighter Futures Counseling?* Yes, please! No, thanks. Please read our Cancellation Policy and confirm you've read and understand.*Cancellation Policy I have read and understand the cancellation policy. Name as it Appears on the Credit Card* First Last Credit CardCard Details Cardholder Name EmailThis field is for validation purposes and should be left unchanged.