This Chair Rocks – A Manifesto Against Ageism – Registration Name: * Required First Last Company: * RequiredAddress: * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone: * RequiredPrimary Contact Email: * Required List your Degrees, Licenses, and/or Certifications: * Required(enter N/A if not applicable)How many year of experience do you have in care management? * Required(enter N/A if not applicable)I would like a CMC CE Certificate: * RequiredYesNoI would like a NASW CE Certificate: * RequiredYesNo($25 fee for CE Certificate)Social Work License #: * RequiredHow did you hear about us?Select OneNACCM NewsletterSocial MediaALCA/Other newsletterColleagueAuthorOtherHow did you hear about us? OtherRegistration Options: * RequiredSelect OneNon-CMCCMC (enter coupon for $20 credit)CMC Coupon Code: * Required ($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.
