Registration

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Details

Name and Description	Qty	Price	Total
Full Marathon (9 CEUs): (For Ethics, Urban Riots, Social Networking, Workplace Survival Marathon! 10-13-16 (Dundalk))	1	$149.00	$149.00

Attendee 1

Personal Information

First Name*

Last Name*

Email Address*

Alternate Email Address

Phone Number*

What is your profession?*

Nurse Physician Professional Counselor Psychologist Social Worker Other

Optional - What is the name of your Agency/Place of Business?

Are you licensed in the State of New York?*

What is your state of *residence*? (even if you are licensed in a different state)*