Request for CE Credits/Hours – May 3, 2024 SymposiumIf you encounter problems with this form or its submission, contact the Chapter: admin@afccny.org Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastDegree *Ph.DPsy.DLCSWMDOtherAFCC-NY is an approved provider of continuing education only for licensed psychologists (#PSY-0114).License NumberEmail *PhoneAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSelect if you attended the Morning Session- 3 creditsMorning Session-The Neuroscience of Substance Use and Misuse-Panel discussion with Dr. Tabashneck with Views from the Bench, Bar, & a Mental Health Professional-Old Tropes, New Trends: Developments in Custody Case LawSelect if you attended the Afternoon Session - 2 creditsAfternoon Session - 2 credits-Should I Stay or Should I Go? Managing Parent-Child Contact Problems -Panel Discussion Reaction to PresentationBy typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signatureName *FirstLastDate of RequestSubmit