Search
Register for a Professional Training (Peninsula)
August 25, 2010 - 11:27pm — gfermin
Your Information
Name:
*
Home Address:
*
Phone Number:
*
Email Address:
*
School Information
Name of your school or agency:
Business phone for you:
Your position:
What age children you work with:
Infant - 3 years
3 - 5 years
School-age
Preteen/adolescence
Teen
More Information
How did you find out about this training? :
Have you participated in other trainings offered by Parents Place? :
Yes
No
Which trainings?:
Would you like to be on our mailing list? If so, please opt in here and be sure we have your email address:
Yes
No
Email Address:
If CEUs (for LCSW or MFT) are requested, please provide your license number:
Please check our website to confirm if CEUs or professional hours are given.
Payment options
Pay by Check:
Please mail check to: 200 Channing Avenue, Palo Alto, CA 94301
Pay by Phone:
Please call 650-688-3040
Pay by Credit Card Online:
Click here
to pay online (This link will open in a new window)
Please select check-box first before clicking on link.
Professional License Name and Number:
CEU Requested (MFT OR LCSW Only):
Yes
No