Please enable JavaScript in your browser to complete this form.This virtual training will be live over Zoom. Participants are expected to join on camera and be fully engaged in the training. *Yes, I agree to have my camera on and participate fully.No"Listening in" via phone or while driving are not acceptable means of participation to be eligible to receive a Continuing Education (CE) certificate.First Name *Last Name *Email *EmailConfirm EmailThis email will be used for you to sign into the Zoom workshop. State or Territory (you are currently working in) *Payment Options *Credit Card - $130.00Agency Check (received on or before July 25, 2024) - $125.00Scholarship - $125.00Scholarship Number * Apply Stripe Credit Card *CardName on CardDo you need an invoice?YesNoYou will automatically receive a receipt for credit card payment via email once you complete your registration.Invoice Information (Agency Name, Address, City, State, Zip)Total$0.00I agree to the terms for substitution, cancellation and refunds. *YesWe are happy to work with you for any substitutions. Cancellations and substitutions for registrations must be in writing and emailed to register@preventiontrainingservices.com at least 5 days before the event begins. Cancellations will incur a $25 administrative fee plus any credit card processing fees. More detailed information can be found at https://preventiontrainingservices.com/wp/terms (link below)Comments or questionsEmailClick here to complete your registration. Terms of Service Contact us if you are having any problems registering or have any questions.