Please complete the following questions to register for this event.

Sunday, March 25, 2018
10 AM - 12 PM
Montage Wellness Center Conference Room
2920 2nd Avenue, Marina, CA 93933

Case Discussions Featuring:
Gloria Miele, PhD, UCLA Integrated Substance Abuse Program
Robin Oakey, LMFT, Janus of Santa Cruz

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Degree/ License (MD, DO, RN, LCSW, etc.)

Question Title

* 4. With which organization (if any) are you affiliated?

Question Title

* 5. What is your role? (ex. Medical Provider, Behavioral Health Provider, Medical Assitant...)

Question Title

* 6. What is your email address? Please take care to enter it correctly, so that we can send you event details and confirmation.

Question Title

* 7. What topics/themes are you interested in discussing at future gatherings?

By completing this survey, you will be registered.

You will receive a calendar invite within a week.
Thank you for your interest in this event. If you have any further questions, please contact admin@hipscc.org.

T