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   Anita L. Giovannucci, MA, LMHC

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Personal Info Form

 

Training & Workshop Registration

Call 518 878 - 5932 for information about the training or workshop you wish to attend.

Check the events page for date & time and the cost of the training or workshop.

Complete this Registration Form

Send your check or money order to the address below

Group Registration:

call 518 878 - 5932 to schedule an assessment appointment.  This first appointment is an Intake assessment session.  The cost is $90 to 125 (sliding fee scale). 

  

For Groups, Presentations or Workshops complete the Registration Form and Send to:  

Anita L. Giovannucci, MA LPCC, LMHC

521 Vischer Ferry Road

Clifton Park, New York 12065

If you are registering for a workshop or several workshops please check the location, date and time or call 518 - 878 - 5932.  Print this Registration Form.  Complete all the information below and send to the address above with your check or money order.

Every workshop must be registered with this registration form and sent to the address above.  Identifying Child Abuse Maltreatment/Neglect workshops must be registered through The New York Mental Health Counselors Association at 

www.nymhca.org

 

Please provide the following contact information:

First Name
Last Name
Middle Initial
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
Web Page

Name the Training, Workshop or Group you wish to attend:

DATE DESCRIPTION

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Web Master: Anita L. Giovannucci 
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Last modified: May 18, 2008