Interested in Signing up for our Classes?

Fill out the form below.
Or click here for the PDF registration form that you can fax, email or mail in.


*Name:


Agency:


*Mailing Address:


*Email:


*Phone:


Fax:


*Course/Workshop you would like to enroll in:


*Date of Workshop:


*Location of Workshop:


*Time of Workshop:


Special Needs request:


*Payment Method:

I have mailed in payment
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I will forward payment within the next 10 days


CEU’s are availible for licensed professionals.

We are approved by CEBroker , The Florida Board of Clinical Social Work, Marriage and Family Therapy
and Mental Health Counseling. Provider Number BAP #_CE Provider #: 50-9339 Also approved for the
CBAP (addictions professionals) 5090- Approved by the Florida Department of Children & Families, Office
of Domestic Violence Programs for BIP Facilitator/Assessor Training

Checks are accepted. Payment is made to:
Dr. Silvernail, PO Box 18745, West Palm Beach, FL 33416
Credit cards accepted via Paypal.
Tuition includes refreshments and informative handouts.


Darlene Silvernail Ph.D LMHC CAP
PO Box 18745
West Palm Beach Fl. 33416
DocSilvernail@aol.com
561-396-0362
Fax 561-735-0985
Solution Graphics