School of Psychology & Counseling

Practitioner-Scholar Conference Registration

Contact conference coordinators at practitionerscholarconference@gmail.com or 865.312.3160

First Name:

Last Name:

Email:

Mailing Address:

City:

State:

Zip:

Primary Phone Number:

To register for Continuing Education (CE) credit, please select from the following ($5 per CE credit):

(1 credit) Speakers: Kathleen McKee, J.D. & Donald Walker, Ph.D., Topic: The Juxtaposition of Law and Psychology in Addressing Issues of Human Trafficking



Total cost $0

Please select which of the following best describes you:

Licensed Clinical Psychologist
Licensed Professional Counselor
Licensed Clinical Social Worker
Licensed Marriage and Family Therapist
Working towards professional licensure but not yet licensed
Graduate Student
Undergraduate Student
High School Student
Other

If other, please describe:

How did you hear about the Practitioner-Scholar Conference at Hampton Roads?

Preferred name/suffix for name tag
(e.g. John Jones, Psy.D.):

School/Organization Affiliation:

Coupon Code:
(Valid until 4/10/14, 11:59pm EDT)

Please send me information about hosting an exhibitor table/booth at the Practitioner-Scholar Conference at Hampton Roads. A conference representative will follow up with you for additional information if you select yes.

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Contact conference coordinators at practitionerscholarconference@gmail.com or 865.312.3160

Regent University