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CM
HOME STUDY REGISTRATION FORM
Please PRINT OUT this form and mail, fax, or phone your registration to
CM Home Study.
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Print Name
_____________________________________
Ship To
________________________________________
Address________________________________________
City______________________
State____ Zip_________
Phone (_____)______________________
 Day
Eve
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Please place my name
on your mailing list.
Please place my name
on your e-mail list.
E-mail
address:
__________________________
0508
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Certifications/Licenses:
CRC
CDMS CCM
RN CVE
NCC LPC
Sub Abuse MFT
LCSW
NOT ALL COURSES HAVE THE SAME APPROVALS. Refer to the Course
Descriptions for details.
Answer sheet must be returned by December 30, 2008
24-hour credit card
order taking service: Credit
Card No. ___________________________________Exp.
Date_________
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Visa
Master Card AMEX
Discover
Debit |
Signature
__________________________________________
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Counseling
Ethics (ETH) |
$ 145
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$
________ |
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Health Care Ethics (HCE) |
$
145
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$
________ |
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Vocational Evaluation (VEV) NEW |
$
125
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$
________ |
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Alzheimer’s Disease (ALZ)
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$
115
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$
________ |
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Rehabilitation Consultant (RCO) |
$
195 |
$
________ |
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Dual Disorders (DUL) |
$
95
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$
________ |
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Strategic Case Management (STC) Course w/ textbook |
$
255
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$
________ |
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Strategic Case Management (STC-E) Registration & exam only |
$
195
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$
________ |
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Substance Abuse and Disabilities (SAD) |
$
95
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$
________ |
Vocational Services and Substance Abuse (VSA)
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$
95
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$
________ |
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Drug Treatment:I (DTA) |
$
95
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$
________ |
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Drug Treatment:II (DTB) |
$
95
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$
________ |
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Enhancing Responsibility (ENR) |
$
125
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$
________ |
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Mental Health Ethics (MHE) Course w/ textbook |
$
165
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$
________ |
Mental Health Ethics (MHE-E) Registration & exam only
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$
135
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$
________ |
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Mental Health Drugs (MHM) Course w/ textbook |
$
185
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$
________ |
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Mental Health Drugs (MHM-E) Registration & exam only |
$
155
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$
________ |
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More Effective Interviewing (MEI) |
$
125
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$
________ |
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Skilled Empathy (SKE)
Course w/ textbook |
$
145
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$
________ |
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Skilled Empathy (SKE-E) Registration
& exam only |
$
110
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$
________ |
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Understanding Disability (UND) Course
w/ textbook |
$
295
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$
________ |
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Understanding Disability (UND-E) Registration
& exam only |
$
235
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$
________ |
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Subtotal |
$
________ |
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The
answer sheet for all courses must
be returned by December 30, 2008
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All
fees valid through
August 31, 2008
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$
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Subtotal
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$
________ |
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Handling,
$10 per
complete course w/ textbook
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$
________ |
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Handling,
$5 per
exam only course
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$
________ |
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If
shipped outside USA, additional $22 per course
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$
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Customs not included
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$
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TOTAL
ORDER
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$
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FOR
FAST SERVICE
ORDER by FAX or PHONE with your Visa, Master Card, AMEX,
Discover,
or
Debit Card
•Fax
your credit card order to (818) 865-9075
•Voice mail credit card order service (818) 865-0514
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OR
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Mail credit card order, check or money order in U. S. Dollars (payable to
CM Home Study) to:
CM Home Study,
30423 Canwood Street, Suite 228, Agoura Hills, CA 91301
Questions? (818) 706-1671 or e-mail
us at: Mail@CMHomeStudy.com
Thank you for your order.
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