To register, please complete the following information and mail with your check payment to :

Inspirit Counseling Services – 5407 N. Charles Street – Baltimore, MD  21210



Inspirit Counseling Services – Caregiver  Retreat-  Saturday  April 25th, 2015  1pm – 5pm – Arbutus UMC

Name:   _________________________________       Phone :_________________________________

Email: __________________________________

Address: ________________________________       Fee Enclosed: _____________


_________________________________________             (optional) CEU Type: ______________________

 Registration should be received by 04/17/2015

Registration Details: The cost for the retreat is $45.   If you are an LCPC, LCMFT, NBCC, or LCSW-C and would like to receive 3 contact hours, please include additional fee of $10                                                     

Inspirit Counseling Services, Inc., is an NBCC Approved Continuing Education Provider (ACEP). Inspirit may award NBCC approved clock hours for events or programs that meet NBCC requirements. The ACEP maintains responsibility for the content of this event. Inspirit Counseling Services, Inc. is NBCC Provider #: 6104.   Inspirit Counseling Services, Inc., has been certified as a continuing education provider by the Maryland Board of Social Work Examiners.