REGISTRATION FORM - Print, Fill Out and Mail

SPECIAL DISCOUNTS IF YOU REGISTER NOW FOR MORE THAN 1 WORKSHOP:

1 Workshop = $119                         3 or 4 Workshops = $108/each
2 Workshops = $114/each                      5 or more Workshops = $103/each

Workshop discounts must be pre-paid and can be used by one person (not multiple people)
Add $10/per workshop for Psychologist CE Credit


NAME ___________________________________

POSITION ___________________________ORGANIZATION _____________________________

Please indicate where you prefer to receive mailings: HOME ____ WORK _____

ADDRESS _______________________________________CITY _________________________

STATE ______ZIP ________ E-MAIL ADDRESS ___________________________________

WORK PHONE ___________________ HOME PHONE _________________________

I want CE credits for:
___ Social Worker CE - ___LICSW ___LCSW ___LSW - Lic # _________________
___ MH Counselor CE - Lic # _________________      ___OT Contact Hours
___Natl Cert Counselor CE    ___Nurse Contact Hours    ___Marriage & Family CE   
___Substance Abuse or LADC CE    ___Psychologist CE ___Educator Certificate   


Dates Location Workshops Fee
Friday, October 30, 2009 Foxborough, MA Lying, Stealing, Temper Tantrums, & School Refusal: Intervention Strategies $119
Friday, November 6, 2009 Billerica, MA The Tigers are Getting Closer—Confronting Trauma, Grief & Loss with Creativity $119
Thursday, November 12, 2009 Springfield, MA When the Mad are Bad: Mental Illness and Violence $119
Thursday, November 19, 2009 Billerica, MA No Such Thing As a Bad Kid: Transforming Troubled Youth Using Strength-Based Practices $119
Friday, December 4, 2009 Billerica, MA The Positive Psychology Toolbox: Practical Interventions for Youth and Adults $119
Thursday, December 10, 2009 Foxborough, MA Finding Help for Struggling Teens: Best Practices and Ethical Challenges $119
Wednesday, January 20, 2010 Springfield, MA Limit Setting & Anger Management with Children & Adolescents $119
Thursday, January 28, 2010 Billerica, MA Is It In You? Using Playfulness to Heal & Strengthen Children Impacted by Trauma $119
Friday, February 5, 2010 Billerica, MA The Anxiety Epidemic: Strategies for Treating Anxiety Disorders in Youth & Adults $119
Thursday, February 11, 2010 Foxborough, MA Violence, Psychiatric Disorders, & Substance Abuse in Youth & Adults $119
Friday, March 5, 2010 Billerica, MA Getting Dads Involved: Building the Connection Between Dads & Their Sons/Daughters $119
Wednesday, March 10, 2010 Billerica, MA Providing Beyond the Fence: Challenges in Home-Based and Wrap-Around Care $119
Friday, March 12, 2010 Springfield, MA Asperger's Syndrome & Nonverbal Learning Disability: Differential Diagnosis & Treatment $119
Friday, March 19, 2010 Billerica, MA Psychotropic Medication for Childhood & Adolescent Disorders $119
Friday, April 9, 2010 Billerica, MA All the Rage: Best Practice for Helping Adolescent Girls in Crisis $119
Thursday, April 29, 2010 Springfield, MA Teaching Attachment-Focused Parenting: Connections that Heal $119
Friday, May 7, 2010 Foxborough, MA Anger, Rage & Trauma: Talking to Kids About Difficult Things $119
Friday, May 14, 2010 Billerica, MA Navigating the Minefield: Working with Couples $119
Thursday, May 27, 2010 Foxborough, MA Holding the Hope: Working with Clients with Borderline Personality Disorder $119
Friday, June 4, 2010 Billerica, MA Managing the Complexities of Schizophrenia & Other Serious Mental Illness $119
Friday, June 11, 2010 Springfield, MA Psychopharmacology for Adults: A Guide for Non-Medical Mental Health Professionals $119
Friday, June 18, 2010 Billerica, MA The Resilient Healer: Taking Care of Yourself While Caring for Others $119
Thursday, July 22, 2010 Billerica, MA Can We Teach These Kids To Dance? Trauma & Attachment-Informed Treatment $119
Thursday, August 05, 2010 Billerica, MA Children & Adolescents with Emotional & Behavioral Problems: Intervening at School $119
Total number of Workshops ____at $ ____each = TOTAL:$______
Psychologists - - Add $10 CE Fee per Workshop = TOTAL: $______
TOTAL FEE: $______

All Major Credit Cards Accepted
All major credit cards accepted

Please charge my: MC__ VISA__ DISCOVER__ AMEX__

CARD #________________________ EXP. DATE_________

SECURITY CODE #________ SIGNATURE____________________________

Mail with your non-refundable check to:

Community Program Innovations, Inc.
471 Broadway, Lynnfield, MA 01940.

Payment must accompany registration form.