Workshop Registration for Grow Deep Counseling

Workshop Registration for Grow Deep Counseling
Name*

First NameMiddle NameLast Name
Degree/Credential/License type and Number or N/A *
Number of Years in Practice
State/Jurisdiction where Licensed or of Practice
Are you currently a clinical supervisor?

YesNoNot right now but considering it OR plan to beNot right now but have been in the past
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you attended a prior workshop by Kristin Ryan/Grow Deep Counseling?*
If have NOT attended a prior workshop, how did you hear about us?

Friend, Colleague, Co-worker, SupervisorProfessional associationEmail advertisement, ListServWeb search and/or Grow Deep Counseling websiteOther
When submitting this form, I acknowledge that I have read, understand and accept the information, including CE certificate re-issuance and Cancellation Policies, stated on the Grow Deep Counseling website, Workshops & Trainings page.
Payment ($125) Type Selected

PayPal directly to krisryanlpc@gmail.com or request an invoiceCredit Card (contact Kristin Ryan Easley to provide card number, expiration date, code on the card, and billing zip code)Check (contact Kristin Ryan Easley for mailing address)Zelle to kreasley22@gmail.com
Workshop Desired

Supervision (Ethics)Supervision (Foundations)Supervision (Methods)Supervisory RelationshipSupervisor DevelopmentSupervisor DocumentationSupervision OR ANY practitioner- Understanding the Counseling ProcessSupervision OR ANY practitioner- Understanding & Developing Professional IdentityAssessing & Managing Suicide RiskEthics: Identifying as a Christian and a Counselor/Therapist/SWEthics: Understanding & Navigating Professional BoundariesOther
Please state the MONTH in which workshop is offered that you are registering (since multiple dates are often offered)
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