Please complete this form to register for the Psychedelic Therapy Training Program mailing list.
*
indicates required
Name:
Email:
Comment:
Email Address:
*
First Name:
Last Name:
Zip Code:
Please select the option that best describes you:
*
Current MSW Student
Future MSW Student
MSW Faculty
Practicing Social Worker
Current Student (not MSW)
Future Student (not MSW)
Faculty (not MSW)
Mental Health Provider (not Social Worker)
Medical Provider
Other
I am affiliated with:
*
Columbia University
University of Pennsylvania
Another University or College
A Psychedelic-Assisted Therapy Organization
Other
