• Identification

  • As you would like them to appear on certificates and conference related publicity
  • Please write a biographical sketch and/or copy and paste your vitae/resume in the space below
  • Workshop

  • Please explain how this workshop contributes to the advancement or enhancement of professional skills and knowledge of substance abuse counseling/social work. (2-5 sentences)
  • The title you would like to appear on the certificate and conference related publicity
  • Please state (in measurable terms) at least 3 proficiencies the participants will receive from your instruction
  • For the conference program (3 – 10 sentences)
  • Check all that apply
  • By checking yes below, I verify that I am currently certified/licensed in my area of expertise, and/or can show evidence of specialized training and/or experience in the last five years of this subject matter, and am free from any disciplinary action by the Ethics/Standard Committees or any other credentialing committees.