Order Form
Fax this to 561-642-3144 after you pay online
or mail with your check.
NAME: ______________________________________________________________________
LICENSURE NUMBER AND TYPE FOR THE CE BROKER: _________________________
E-MAIL: _____________________________________________________________________
ADDRESS: __________________________________________________________________
____________________________________________________________________________
PHONE: ____________________________________________________________________
FAX: _______________________________________________________________________
METHOD OF PAYMENT: ______________________________________________________
QUANTITY: __________________________________________________________________
Our educational programs have been approved by the DCF Office of Domestic Violence, The Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling. CE Broker Tracking #: 20-221586. Provider Number BAP #_CE Provider #: 50-9339 The Certification Board of Addictions Professionals CE Provider #5090
