Registration Form

Collaborative Problem Solving

04/27/2018

-EVENT LOCATION-
San Fernando Valley Community Mental Health
14545 Sherman Circle
Van Nuys CA 91405

Contact Info:
Mark Riddle (310) 466-1269
latconline@gmail.com

IMPORTANT INFORMATION:

All training modules start promptly. Please allow for traffic conditions when planning trip.

DUE TO LIMITED SPACE, THERE IS NO PARKING ON SITE.
Free parking is available across Sherman Circle in the Medical Plaza’s parking structure. Training attendees may park on the 3rd level or above for free.

Lunch is not provided.
 

Trainee Information

Name Of Trainee:
Position of Trainee:
Email Address of Trainee:
Agency:
Service Provider Area (SPA):
*For LA County Agencies Only
Program Manager's Name:
Program Manager's Phone:
Program Manager's Email:
6 CEU's are available for this training for those that qualify. There will be an additional $10 cost for processing.
I would like to get CEU's: -YES    -NO  
Your License Numer:
(Enter ONLY if requesting CEU's)

Class Information

Date Location Cost
Apr 27, 2018
9:00am-5:30pm

San Fernando Valley Community Mental Health
14545 Sherman Circle
Van Nuys CA 91405

Contact Info:
Mark Riddle (310) 466-1269
latconline@gmail.com

 $150





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