Opening Day CEU/CE Payment Form

First Name and Last Name, Academic Credentials*
First Last Suffix
Enter the name and credentials that will appear on your name tag (please put the academic degree rather than a license). Ex. Jane Smith, PhD; John Smith, MSW.
Email*
Phone
CEU/CE
- Counseling CEs - $15
- Social Work CEUs - $15
- New York Social Work CEUs
Total
$0.00