Hello and thank you for interest in the August 2017 Training Institute at the University of Cincinnati, specifically the Cognitive Behavioral Interventions for Substance Abuse (CBI-SA) session August 7-9, 2017.

Please fill in the registration information below, typing or clearly printing and return to to confirm your intent to attend this session.

CBI-SA END USER TRAINING – AUGUST 7-9, 2017
Name:
Agency:
Address:
City:
State:
Zip:
Email Address:
Phone:
TOTAL COST: / $1,000.00
Method of Payment: / Credit Card / __ / Purchase Order / ___ / Check / ___
Immediate Supervisor Name:
Supervisor Email:

Payment Information:

The simplest method of payment for your registration is via CREDIT CARD, which can be accessed HERE. If you need the link emailed to you, please let us know when you email your registration form to .

If you will be paying with CHECK or PURCHASE ORDER, please also return the following information with your registration form.

Agency Name:
Billing Contact:
Contact Email:
Federal ID Number:

Once this information is received, we’ll email you an invoice to use for processing payment via check or purchase order.

Shortly after we receive your registration, you will receive a follow up email confirming your spot in the Cognitive Behavioral Interventions for Substance Abuse training Aug 7-9, 2017. Thank you for your registration and please feel free to email should you have any additional questions.

We look forward to seeing you for the August 2017 Training Institute!