NACCM Media Club: Who is in Charge Anyway? An Exploration of Personal Empowerment and the film, “I Care A Lot” Registration Name:* First Last Company:* Mailing Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone:* Primary Contact Email for Registrant:* List your Degrees, Licenses, and/or Certifications:* (enter N/A if not applicable)How many year of experience do you have in care management?* (enter N/A if not applicable)I would like a CMC CE Certificate:* Yes No I would like a NASW CE Certificate:* Yes No ($25 fee for CE Certificate)Social Work License #:* How did you hear about us?*Select OneNACCM NewsletterSocial MediaALCA/Other newsletterColleagueAuthorOtherN/AHow did you hear about us? Other* Registration Options:*Select OneNon-CMCCMC (enter coupon for $20 credit)CMC Coupon Code:* ($20 discount)TOTAL: $0.00 Once you press "Pay Now", you will be redirected to Paypal.com. You must complete your payment before your registration is received and processed.You will receive email notifications with event details and instructions prior to the event. Δ
