Registration for Professionals

ACT Workshop Series

March 21, 2026

Contact Information

*First Name:

*Last Name:

*Name as it should appear on Name Tag :

*Email:

*Street Address:

*City:

*State:

*Zip Code:

*Phone Number:

Additional Information

*Organization:

License Number (CE Credits):

*Profession:

*Do you have any food restrictions?(type N/A if none)

Are you seeking CEs?

Yes, I'd like to receive CEs. No, I would like to attend without receiving CEs.

Comments

PayPal and Registration Confirmation

After hitting “submit” you will be directed to PayPal to finalize payment. Please enter your (attendee's) name in the popup window regardless of who is paying for the registration.

We will send your registration confirmation within 24 hours. If you do not receive a confirmation right away, please do not register again.