Registration form for the June 2023 MMPI Research Symposium in Minneapolis, MN

 

Conference dates: Thursday, June 22 - Friday, June 23, 2023

Attendee Information

Details required for processing Continuing Education (CE) Credit. Please note that you will be asked for the billing name and address on the payment form.

Full Name  

Phone Number  

Email  

Title / Degree   Please let us know the attendee's title or degree (education level), such as PhD, PsyD, MeD, MD, LCSW, etc. Please elaborate in the License Number field below if "Other" was chosen. Thanks!

...PhDPsyDMDEdDM.Ed.MFWMSWMPSMSMALMFTLCPLPCABPPGraduate StudentOTHER...

License Number Please let us know the attendee's license number and the state in which it is held.

Attendee address

Address 1  

Address 2

City  

State   (If in the U.S.)

Please select one.None (outside the U.S.)AKALARAS (American Samoa)AZCACOCTDCDEFLGAGU (Guam)HIIAIDILINKSKYLAMAMDMEMIMNMOMP (Northern Mariana Islands)MSMTNCNDNENHNJNMNVNYOHOKORPAPR (Puerto Rico)RISCSDTNTXUTVAVI (U.S. Virgin Islands)VTWAWIWVWY

State/Province/Territory (If outside the U.S.)

ZIP/Postal Code  

Country Code

MMPI Research Symposium

2-DAY SYMPOSIUM: June 22-23, 2023  

$225.00 - Non-student (regular) rate$125.00 - Student rate

How did you learn about this program?

Please select one or more of the following:  

I am a past attendee Email from Pearson Social Media Colleague Other

If you chose "Other," please specify: