RS/C Provider Training Spring 2023

With this VIRTUAL EVENT, professionals can develop skills for providing safe, regular, and collaborative support for their colleagues and staff. This training series enables leaders to expand the use of feelings, impact of values and sharing in parallel process to enhance other professionals’ work with families and peers.

RS/C Provider Training Spring 2023 REGISTRATION

My Info

First Name *

Last Name *

Personal Email Address *

Home Address *

City *

State *

Zip *

My Personal Phone Number *

Name of Agency/Employer *

Job Title *

My Work email *

My Work Phone Number *

I would like to *

participate as a NJ-AIMH Member at $400. My NJ-AIMH Member code (on my 2023 membership confirmation) is:participate as a NJ-AIMH Member at $400. My NJ-AIMH Member code (on my 2023 membership confirmation) is:

participate as a Nonmember at $500

Discipline, e.g., early childhood education, social work, psychology, nursing, pediatrics, counseling, OT, speech therapy, etc. *

I use the following pronouns: *

he/him/his

he/they/their

she/her/hers

she/they/their

they/them/their

OtherOther

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I identify racially/ethnically as: *

Asian

Bi-racial

Black

Indigenous

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Multi-racial

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OtherOther

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I hold Infant Mental Health Endorsement (IMH-E®) *

Yes, which categoryYes, which category

No

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