MI – IP Registration – 8.4.2

Please Read Prior to Completing this Registration

In order to be eligible and register for the MI-IP Series, applicants are required to complete the 4-hour, free self-paced, online course Tour of MI: An Interprofessional Road Map for Behavior Change. Please submit the electronic copy of your certificate of completion during the registration process.

Name*
First Last
Credentials*
Agency/Organization*
Job Title/Position*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
State where you work:*
State
Work Phone Number*
Mobile Phone Number*
(MPATTC Staff 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 automated texting platform.)
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 learn about this event?*
Do you have a background or have you attended Motivational Interviewing training for use in clinical practice?*
- Yes
- No
Please Explain;*
What do you hope to learn by taking the MI-IP Workwise Series?*
Tour of MI Certificate of Completion – Upload to System*
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.