License Exam Preparation Workshop Registration
TITLE: (Ex. Dr/Ms/Mr/Mrs/Miss)   

Last Name:                                                                   First Name:                        


Home Address:

Home City:

Home State:                                                                    Home Zip Code:

Primary Email:       


Are you a NYMHCA Member?                                      Membership number:

Membership Type:  (Professional/New Professional/Student/Retired/Associate)                                                                         

Work Setting:

Workshop Fee Schedule:                                                                  

Training of 1-25 people:     $275 per person (NYMHCA Member)    $350 per person  (Non-Member)     

You can only register for a workshop if you have contacted a presenter and have received a commitment from the presenter and a date of the training.  No presenter listed on this website can offer a workshop that is not sponsored by NYMHCA.

Date of Workshop:

Workshop Presenter:

Location of In-person Workshop:                                                           
Printable RegistrationForm.pdf
Printable RegistrationForm.pdf
  *You must register for a workshop at least 24 hours before it begins.  Anyone who attempts to       register less than 24 hours before a workshop will not be on the presenter's registrant list and   will NOT be admitted!

 To ensure your admittance to a workshop, we suggest that you bring with you a copy of the email   confirmation of your registration that you received from our office.
Click on Submit to send us your registration and to be taken to the payment page.