January 2025 Virtual LPC Supervisor 6 Hour Update Sign Up

LPC Supervisor 6 Hour Update Sign Up

Friday, January 17, 9:00am - 3:30pm *Virtual Only*
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
LPC License Number*
Do you currently have any supervisees?*

YesNo
If yes, how many?*
Are you currently accepting new associates for supervision?*

YesNo
Do we have your permission to share your name and contact information with the participants of this training?*

YesNo
Please upload a headshot or other preferred picture of yourself to be used for the training.*

Cancelof
Please provide us with your professional contact info for networking. Example: Business name, website, business phone number, business email, etc*
This training is a live in person training only. The in person location of this training will be held in the south Arlington/Mansfield area. The specific location will be determined by the number of clinicians who sign up. You will receive the specific address closer to time for the training.
This training is a live virtual training only. As always, Mending Clinic continuing education events are interactive and will include group discussion. You will be required to have your camera on for the entire duration of the training.

The Zoom Meeting invitation and a reminder will sent two days before the training is held.

I would like to sign up for:*

Virtual TrainingThis training is a live virtual training only. As always, Mending Clinic continuing education events are interactive and will include group discussion. You will be required to have your camera on for the entire duration of the training. The Zoom Meeting invitation and a reminder will sent two days before the training is held.

$200.00

Enter coupon

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Lunch will be provided. Please put any dietary restrictions in the box below, or put n/a if you have no restrictions.*
T-Shirt Size (men's/unisex sizing)

SmallMediumLargeExtra Large
For virtual participants, we will be sending you some hands-on training elements. What is your mailing address?*

Street Address

Street Address Line 2

CityState

Zip Code
Should be Empty: