1/11/23 2 CEUs Seminar Registration Form

                                               *  *  *  *  PLEASE NOTE:  *  *  *   *      

       IF YOU HAVE A PROBLEM REGISTERING, CALL SUSAN AT 516-459-9036.  

                                                              *    *    *    *                                                                                                            

               ►   ►   ►   ►  PLEASE READ ALL INFORMATION BELOW BEFORE 

                                        FILLING OUT THE REGISTRATION FORM.    

                                                             *   *   *   *   *   *   *  

                 ► ► TOPIC:    SELF-COMPASSION: The Crucial Missing Link to 

                                        Achieving Consistent, Optimal Self-Care                               

                                   ► ► SPEAKER:  Susan Eisner, MPH, CASAC

                                        President, Visionary Health Solutions LLC              

                                                                      2 CEUs:

► 2 CEUs for Social Workers - LMSWs & LCSWs & Case/Care Managers - CCMs             

            ► ► WHEN:  DATE:  WEDNESDAY – 1/11/23    TIME:  5:30 to 8:30 pm 

                         ► ► LOCATION:   Flushing House Assisted Living

                                                          38-20 Bowne Street

                                                          Flushing, NY 11354  

                                                           *    *    *    *    *    *   

                                                    ►  ►    IN ADDITION:                                  

                                     ►   ►  ►  ►   VERY, VERY IMPORTANT:   

                 On top of the registration form BELOW, IGNORE THE WORDS: 

                   “SWITCH ACCOUNT. *Required.” DO NOT sign into Google.    

      ►  ►  SIMPLY START FILLING OUT THE FORM BY ENTERING YOUR FIRST 

                      NAME IN THE SECOND WHITE BOX. COMPLETE THE REST.

           ►  ► ►  ► BEFORE YOU HIT “SUBMIT” BE SURE TO READ ALL THE 

                           INSTRUCTIONS IN THE LAST BOX OF THIS FORM.