Payment Form for CwF

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
Fee*
- Conference Fee - $65
Terms of Agreement*
I agree to the Terms of Agreement
- By registering for the Conversations with the Faculty, I understand all webcasted material is to be utilized for its intended educational purpose. All content is to be considered confidential.

- By registering for the Conversations with the Faculty, I consent to have any video image and audio from my site recorded and used in further sales.
Total
$0.00