event request

Webinar/Event Request Form

Use this form to send information to the Engagement Team for publication to our Website, Facebook pages and communication to members via Mail Chimp.

Registrations for events will be sent to [email protected]

Event General Information

* Indicates required field

Title of Event *

Date and Time of the Event *

Name of Presenters (and their credentials) *

Upload a photo of the presenters *

Max file size: 20MB

Additonal Photo (If applicable) *

Max file size: 20MB

CEU Information

How many CEUs are available? *

How many of the CEUs are Ethics CEUs? *

How many of the CEUs are Supervision CEUs? *

Member cost - No CEUs (If Blank, we will use the default cost of 0) *

Member Cost - With CEUs (If Blank, we will use the default cost of $15) *

Non-Member Cost - No CEUs (If Blank, we will use the default cost of $40) *

Non-Member Cost - With CEUs (If Blank, we will use the default cost of $40) *

Event Details

Summary of Event *

Learning Objectives *

Upload a Summary of the Event and Learning Objectives *

Max file size: 20MB

All event registrations will require the following information from the registrant: name, email, certification number. If you require additional information please include below.

Additional Information *

Event Zoom Information

Paste Zoom Link and info here to be sent automatically to registrants *

Request Submitted by:

Name *

First

Last

Email *

All requests will be reviewed by the Engagement Team. If information is missing, or clarification is needed, we will be in touch with the person making the request.

Information submitted via this form is sent directly to Janice Mullin to add to the website. Registration forms will be available on the website within 5 business days of receiving the completed request.

Once the registration is open, promotion of the event will also be put on our Facebook page (both public and members only), and distributed via MailChimp. Any changes to this will be at the discretion of the Engagement team.

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