Pearls & Pitfalls Series Registration Form
May - September 2023
Name
*
First Name
Last Name
Email Address
*
Contact Number
*
NPI #
*
If n/a please type 0000
Registration
Please select all sessions you would like to attend
Session 1
FULL
Session 2
June 1 12:30p Human Trafficking & Peds Patients
Session 3
June 15 12:30p Impact of Racism & Bias
Session 4
June 20 6:30p Suicidality & Safety Planning
Session 5
July 18 6:30p Advocacy & Integration of Behavioral Health
Session 6
August 1 6:30p Anxiety & Depression
Session 7
Aug. 3 12:30p Treating Eating Disorders
Session 8
Aug. 15 6:30p Immigrant & Refugee Mental Health
Session 9
Aug. 29 6:30p Vaping, Smoking & Marijuana
Session 10
Sept. 7 12:30p Caring for LGBTQ+ Youth
Session 11
Sept. 19 6:30p Pre-School & School Age Aggression
Session 12
Oct. 5 12:30p Social Media & Parental Control
Session 13
Oct. 10 6:30p Coding Documentation & Pay Parity
Session 14
Oct. 17 6:30p Pediatricians as Psychiatrists: Avoiding Legal Pitfalls
Session 15
Oct. 19 12:30p Collaboration w/Child Psychiatry
Session 16
Oct. 26 12:30p Transference & Vicarious Trauma
Is this your first time registering for an event in this series?
*
Yes
No
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Demographic Information
Please skip this section if you have previously registered for an event in the Pearls & Pitfalls Series
Which of the following applies
MD/DO
NP/CPNP
PA
LCSW/LMHP
NPI Number (if N/A please fill with 0's)
Practice Zip Code
5-Digit Zip Code
Please select your age range.
20-30
31-40
41-50
51-60
60+
In which of the following have you participated?
VMAP REACH PPP Training
VMAP Project ECHO
VMAP Consult Line
None of the Above
Would you like more information about VMAP?
YES
NO
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Thank You!
You will receive a registration confirmation email & ZOOM link to the series upon submitting this registration form. Additional sessions coming October - December will be posted soon. Look for an email for your chance to register for these sessions.
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