2 Day Training Registration Form
Select the date and location you are registering for. *
Please select your license/certification. You can make multiple selections.
 
Enter your license number. This is required for continuing education credits from NASW. Click on the + sign if you need to enter more than one license number. OASAS certificates are provided upon request (license numbers not required for CASACs).
Please indicate if you are a member of the following organizations. You can make multiple selections.
Do you operate a private practice (outside of your organization or community based organization)? *
Are you interested in obtaining more information on how to become part of the referral database for problem gambling treatment providers? *
After you click Submit you will receive a confirmation email. 
Check your junk or spam folder if you don't receive a confirmation.