MI - IP Registration - 8.2.1

Name*

First Last

Credentials*

Agency/Organization*

Current Position*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

State where you work:*

Mobile Phone Number*

(MPATTC Staff & Consultants will be sending weekly SMS text messages related to course content (learning extenders). By inputting your phone number, you consent to receive text messages 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 a MPATTC Staff Member at workwise@casat.org)

Enter Email Confirm Email

Password*

Enter Password Confirm Password

Strength indicator

How did you find out about this event?*

What are you hoping to learn from this online series?*

Are you Hispanic or Latino/a?

Yes
No

What is your race?

Specify

Are you currently providing treatment and/or recovery services in the behavioral health field?*

Yes
No

Do you have a background or have you attended Motivational Interviewing training for use in clinical practice?*

Yes
No

If yes, please Explain;*

Tour of MI Certificate of Completion – Upload to System*

Max. file size: 64 MB.

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.

Please Read Prior to Completing this Registration