Hiring and Leading Staff in Evidence-Based Practices – Registration

Name*

First Last

Credentials*

Agency/Organization*

Current Position*

Addiction Counselors
Nurse Practitioners
Nurse
Peer Recovery Support Positions
Physician
Physician Assistants
Prevention
Social Workers

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Mobile Phone Number*

(Mountain Plains ATTC Staff & Consultants will be sending weekly SMS text messages related to course content. By inputting your phone number, you consent to receive text messages sent through an automatic telephone dialing system.)

Email*

(By providing your email address, you will automatically be added to the Mountain Plains ATTC listserv; to opt-out, please contact Trisha Dudkowski at mpattc@casat.org)

Enter Email Confirm Email

Password*

Enter Password Confirm Password

Strength indicator

By checking here you are indicating that you understand the pre-requisite and technology requirements as well as the time commitment to participate in this training.*

I understand the time commitment involved and agree to fully participate.