CMHRC | Seminar or Webinar Slideshow Request Form
Use this form to purchase a copy of the slideshow used during one of CMHRC's webinar or clinical seminar events.
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CMHRC | Seminar or Webinar Slideshow Request Form
Use this form to purchase the slideshow from one of CMHRC's live webinar or clinical seminar events.
$
25.00
Quantity
1
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Name
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First Name
Last Name
Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Role
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Professional
Family
School
Media
Community Partner
Other
Professionals: Please share your Job Title(i.e. Outreach coordinator, foster care support, school counselor, etc.)
Professionals: Please share the name of the Organization where you work (if applicable)
Type 0f Professional
Child Care Provider
Nurse
Nurse Practitioner
Occupational Therapist
Other
Physician
Physician Assistant
Physical Therapist
Psychiatrist
Psychologist
Psychotherapist
School Counselor
Social Worker
Speech Therapist
Student
Teacher
Services
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Webinar
Clinical Seminiar
Slideshow Requested
*
Please share how you intend to use this slideshow.
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I understand that this slideshow and it's content is the intellectual property of, and copyrighted by, CMHRC.
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Yes, I understand and agree to adhere to these terms.
I understand that this slideshow is being made available for my personal reference only.
*
Yes, I understand and agree to adhere to these terms.
I understand that no reproduction or distribution of this slideshow or its content is allowed.
*
Yes, I understand and agree to adhere to these terms.
I understand that if I wish to share this information with colleagues, clients, patients, family members, or friends, that I must contact CMHRC for information on how to appropriately collaborate with CMHRC and its staff.
*
Yes, I understand and agree to adhere to these terms.
I understand that by requesting this slideshow I am authorizing CMHRC to send me emails and other communications relevant to their work and mission.
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Yes, I agree to receive emails from CMHRC
Please verify that you are human
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