Training Registration for KY Specific Trainings 2021 Kentucky Trainings 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 AfghanistanÅland IslandsAlbaniaAlgeriaAmerican 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 RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican 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 RicoQatarRéunionRomaniaRussiaRwandaSaint 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 IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe 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. Understanding Suicide–What Mental Health Professionals Need to Know About Assessing and Managing Suicide Risk ($100.00)September 17, 2021 (9:00 AM -4:15 PM EST) * Understanding Suicide6 Hour CE Class for Suicide Mgmt. KY Board Approved for Counselors, Social Workers, Psychologists, and Pending Approval for Marriage and Family Therapists **Currently Provided via Webinar** *Meets Mandatory Suicide training Requirement*Domestic Violence for Mental Health Practitioners ($50.00)September 3, 2021 (9:00 AM - 12:15 PM EST) * DV Class3 Hour CE Class about Domestic Violence. KY Board Approved for Counselors, Social Workers, Psychologists, and Pending Approval for Marriage and Family Therapists *Meets Mandatory Domestic Violence training Requirement* **Currently Provided via Webinar**Professional Counseling Law and Ethics ($50.00)September 3, 2021 (1:00 PM - 4:15 PM EST) * Professional Counseling Law Class3 Hour CE Class on Professional Counseling Law and Ethics.. KY Board Approved for Counselors. *Meets Mandatory Counseling Law training Requirement* **Currently Provided via Webinar**Marriage and Family Therapists—Understanding the AAMFT Code of Ethics ($50.00)September 10. 2021 (9:00 AM - 12:15 PM EST) * MFT Ethics Class3 Hour CE Class on Marriage and Family Therapy Ethics. KY Board Approved for Marriage and Family Therapists. *Meets Mandatory MFT Ethics training Requirement* **Currently Provided via Webinar**Social Work Ethics for License Renewal ($50.00)September 9. 2021 (1:00 PM - 4:15 PM EST) * SW Ethics Class3 Hour CE Class on Social Work Ethics. KY Board Approved for Social Workers *Meets Mandatory SW Ethics training Requirement* **Currently Provided via Webinar**Pediatric Abusive Head Trauma: Understanding Risks, Outcomes, and Prevention ($50.00)September 9. 2021 (9:00 AM - 10: 30 AM EST) * Ped. Abusive Head Trauma Class1.5 Hour CE Class on Pediatric Abusive Head Trauma. KY Board Approved for Social Workers *Meets Mandatory Pediatric Abusive Hear Trauma training Requirement* **Currently Provided via Webinar**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 Card Card Details Cardholder Name EmailThis field is for validation purposes and should be left unchanged.