Co-Occuring Disorders for Patients with Mental Health Concerns & SUDs 8.2.1 Registration

Name*

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Credentials*

Email*

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Password*

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Agency/Organization*

Current Position*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Daytime Phone Number*

Mobile Phone Number*

Mountain Plains MHTTC Staff will send weekly SMS text messages related to the series content. By inputting your phone number, you consent to receive SMS text messages sent through an automatic telephone messaging system.

How did you learn about this event?*

What do you hope to learn by participating in this online learning series?*

Rate your familiarity with using Zoom or another video conferencing platform:

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By checking here you are indicating that you understand the pre-requisite and technology requirements as well as the time commitment to participate in this training.*

▪ I understand the time commitment involved and agree to fully participate.