Mental Health Professionals Collaboration Registration Page

Please complete form below to register for the 2010 Mental Health Professionals Collaboration.

Fields marked with * are required.

First Name *

Last Name*

Credentials

Last 4 digits of SS#*

Organization/Agency

Address*

City*

State*

Zip Code*

Phone Number*

Email Address*

Payment Information

The fee for the Mental Health Professionals Collaboration is $75.
Please select your payment method below:

Check***

Visa

MasterCard

Credit Card Number

Expiration Date

Expiration Year

***Please make checks payable to "MUSC Psychiatry" and mail to:
Caitlin Norfleet
MUSC Psychiatry – Post Graduate Education Office
51 Bee Street; MSC 861
Charleston, SC 29425

Continuing Education Credit

Please select the type(s) of credit you wish to receive:

LPC, LMFT, LPES - 7 hours of CE credit

Social Workers - 7 hours of general credit

Psychologists - 7 Category A credits

Other - .7 Continuing Education Units

Comments or Special Needs (physical or dietary)

If you have any questions or would like to register by phone, please call (843) 792-0175.

Institute of Psychiatry : Events : 2010 Mental Health Professionals Collaboration : Mental Health Professionals Collaboration Registration Page