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Please fill out this pre-registration form to be considered for the motivational interviewing (MI) introduction and application course.  Pre-registration is the first phase of course registration process. If you do not submit your pre-registration form, you will not be able to register for the course.

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* 1. Please indicate your name, email address and work title/position

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* 2. Briefly describe the patient population with whom you work.

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* 3. Briefly describe your practice setting and your main responsibilities with patients

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* 4. Indicate your interest in this course (you may select more than one response)

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* 5. Please indicate your preferred time to attend course sessions in the MORNING (you may select more than 1 time slot)

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* 6. Please indicate your preferred time to attend course sessions in the AFTERNOON (you may select more than 1 time slot)

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* 7. I prefer EVENING sessions ONLY

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* 8. What questions, concerns, comments and/or recommendations would you like educational planners to consider when developing the course schedule

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* 9. CAMH staff members, please provide your CAMH email address

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