Order Form - Please fill out this order form and fax back to 561-642-3144 or include with check.
NAME: ______________________________________________________________________
LICENSE TYPE AND NO. FOR CE BROKER: ______________________________________
E-MAIL: _____________________________________________________________________
ADDRESS: __________________________________________________________________
____________________________________________________________________________
PHONE: ____________________________________________________________________
FAX: _______________________________________________________________________
METHOD OF PAYMENT: ______________________________________________________
QUANTITY: __________________________________________________________________
This Workshop has been approved for 8 contact hours by the DCF Office of Domestic Violence.
CE Broker Tracking #:20-195509. 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. Provider Number BAP#_CE Provider #: 50-9339 and The Certification Board of Addictions Professionals CE Provider #5090
