Therapist Social Event
We would love to get to know you! Please fill out the form to complete registration!
**If you’re a returning member, only fill out required questions.
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Email *
Full name *
Birthday
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Returning member?
Address
Phone number
Professional or personal Instagram handle (optional)
What type of mental health professional are you?
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What setting do you work in?
What is the name of the organizationyou work for ?
What population do you work with ?
What are your areas of focus?
How did you learn about our event?
How do you hope this group will benefit you?
Register with a friend and get 10% off! List your friends full name: (applies to first time participants only)
Please select the date(s) you are registering for! Please write the date of the event when you submit the payment via Venmo. *
Required
By checking this box I am registering for the event and agree to pay the all inclusive fee of $65. I understand that if I do not pay the fee of $65, 1 week prior to the event that I will lose my seat. This event is first-come-first-serve. Please Venmo Alexa from Healthy Mind Mental Health Counseling at @Alexa-Inserra up to 1 week prior to the event to secure you seat. You will receive a confirmation email regarding the status of your registration. *
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