Please enable JavaScript in your browser to complete this form. Conference I cases BASIC INFORMATIONName *FirstLastPhoneEmail *Organization/Church/DenominationRole/Title/PositionPROFESSIONAL BACKGROUNDEducationField of Expertise/OccupationYears of ExpertiseClinical Training/Backgorund1-2 Units of CPE3-4 Units of CPEOther TrainingConference Participation DetailsHow did you hear about this event? (Referral, Email, Social Media, etc.)What topics are you most interested in?Trauma HealingKintsugi ResilienceDiscussionsCase StudyFaith & Mental HealthOtherDo you have any specific questions or cases you’d like addressed?CONTENT AGREEMENTConfidentiality Agreement Checkbox: "I understand that this Case Conference will involve discussions of real-life cases and sensitive information. I agree to maintain confidentiality by not sharing any identifying details outside this session. By checking this box, I confirm my commitment to upholding ethical and professional standards regarding confidentiality."I agreeSubmit
