Registration Form

* Indicates required fields.
Note: You may enter either Day or Evening Phone, but must have at least one.

 
First Name:*
Last Name:*
Affiliation:
E-Mail:
Address:*
City:*
State:* Zip:*
Phone (Day):* - -
Phone (Evening): - -


Please indicate which of the following lectures you would like to attend.

For these programs, please make checks payable to 'Four Winds Hospital'

May 14 The Diagnosis and Treatment of Co-Occurring Substance Use and Other Psychiatric Disorders. Fee: $15.

For these programs, please make checks payable to 'Four Winds Foundation'

Apr 16 The Kids are Alright: Ensuring Happiness, Hope, and Healing in the Midst of a Family Health Crisis. Fee: $20.
May 6 Child Abuse Identification and Reporting. Fee: $45.

These programs are Free of Charge

Apr 27 Nursing Career Day. Free of Charge
May 5 National Depression Screening Day. Free of Charge. For information, or to schedule a confidential appointment, please call 1-800-546-1754 ext. 2413.

Certificate of Attendance available for all programs.