NASW-VT Chapter Continuing Education Program Clinical Supervision Register Payment Form NON-MEMBER REGISTRATION If you are a current member of NASW-VT in good standing, there is no fee to be listed on the Clinical Supervision Register. If you are not a member of NASW-VT, but wish to be included on the Register, there is an application fee of $250.00. After that, a $200 annual renewal fee or ~ for less ~ you can become a member of NASW and receive this member benefit for FREE! Please include a check with your application or fill out the credit card information below. Applications from non-members will not be processed without payment. IMPORTANT: If you are registering by credit card, please include the 3 or 4-digit CVV number on the back of your credit card. Payment Method (Please check appropriate method): Check# _______ Credit Card ____ . Visa MasterCard CC # Exp. Date  Name on Signature CVV Code Card Check Number: Check OPTIONAL SECOND LISTING To be listed in two counties on the Clinical Supervision Register, there is a $25.00 fee. Please include a check with your registration or fill out the credit card information below.
NASW-VT Chapter Continuing Education Program Clinical Supervision Register Payment Form NON-MEMBER REGISTRATION If you are a current member of NASW-VT in good standing, there is no fee to be listed on the Clinical Supervision Register. If you are not a member of NASW-VT, but wish to be included on the Register, there is an application fee of $250.00. After that, a $200 annual renewal fee or ~ for less ~ you can become a member of NASW and receive this member benefit for FREE! Please include a check with your application or fill out the credit card information below. Applications from non-members will not be processed without payment. IMPORTANT: If you are registering by credit card, please include the 3 or 4-digit CVV number on the back of your credit card. Payment Method (Please check appropriate method): Check# _______ Credit Card ____ . Visa  MasterCard CC # Exp. Date Name on Card Signature CVV Code Check Check Number: OPTIONAL SECOND LISTING To be listed in two counties on the Clinical Supervision Register, there is a $25.00 fee. Please include a check with your registration or fill out the credit card information below.
supervision-list-for-state-of-vt.docx