DCF Subscription Series Registration Form
(for Department of Children and Families Staff ONLY)
One (1) Registrant per Form
Name:
Position:
Organization:  Department of Children and Families
 Work Address:
Street: City:
State: MA Zip: Email:
Work Phone: Cell or Home Phone (in case of snow):
Social Worker CE: LICSW LCSW   LSW  Reg. #:
MH Counselor CE:  Reg. #: OT Contact Hours
Nat'l Cert. Counselor CE Nurse Contact Hours Marriage & Family CE
Substance Abuse or LADC CE Psychologist CE     Educator Certificate

IMPORTANT! NEW LOCATION:

» You can register for a MAXIMUM of 3 workshops

Courtyard by Marriott Billerica
270 Concord Road
Billerica, MA 01821
Phone: 978-670-7500

» You will NOT receive confirmation; assume you are registered

» You cannot cancel. If you cannot attend, send a substitute

» Print a copy of this form for your records

» Each workshop is from 9:00 am - 4:00 pm and offers 6 CE hours

Click here for Directions
Select a Maximum 3 Workshop(s) Click on each workshop title to see description
Some versions of Internet Explorer may pop up a window that states "This form is being submitted using email. Submitting this form will reveal your e-mail address to the recipient, and will send the form data without encrypting it for privacy".  If this window appears, click OK and then ALLOW. We are working on resolving this issue, but are a secure site that values privacy, and will only use the information provided for contact purposes.

Contact us:  Community Program Innovations, Inc.
471 Broadway, Lynnfield, MA 01940
Tel: 978-968-2781 Email Us