DBT in the 21st Century: With a Special Emphasis on Suicidal Multi-Problem Adolescents and their Families

First Name *

Last Name *

Kaiser Permanente Email *

Credentials *

License Number *

Facility *

Department *

Professional/Academic Level * Select ... LCSW LMFT LPCC PhD PsyD EdD *Other

*If other please specify

Please choose the type of units that applies to your License * Select ... Continuing Education (CE) for LCSW, LMFT, LPCC, PhD, PsyD, EdD I am not requesting Continuing Eduction Units

I consent to my submitted data being collected and stored as outlined by the site .