CTTS 5-Day Training Registration

Comprehensive Fee for 5-day CTTS Training $975.00 (includes $150 non-refundable registration fee/deposit) till 2017. As of January 2018, our new rate of $1075 will be in effect.

Please submit the online registration form below

To complete your registration, send a check (made payable to Rutgers-Tobacco Dependence Program). Comprehensive Fee for 5-day CTTS Training $1075 (includes $150 non-refundable registration fee/deposit)
Send to:
Registration, Tobacco Dependence Program
125 Paterson Street, Suite 2300, New Brunswick, NJ 08903
For more information send an email to info@tobaccoprogram.org or call the Tobacco Dependence Program at 732-235-8222

Course starts at 9:00am - 5:00pm (Registration 8:30am to 9:00am)
We serve breakfast every day and one networking  lunch

TRAINING CONFIRMATION
Upon submitting your registration, a separate confirmation will be sent to you. If you do not receive this within 3 days, please contact us at 732-235-8222.

Choose a Training Date
Preferred Salutation
First Name
Last Name
Age
Sex/Gender
Degrees/Certifications/Licenses
Years counseling experience

Work Setting


 

How many years of experience do you have in tobacco treatment?
How many hours a week do you conduct tobacco treatment?
Why do you wish to attend this training?

 

Title
Organization
Address
Address2
City
State
Zip
Work Phone
Work Fax
Email

We are proud that our trainees come from far and wide, nationally and internationally
and we know there are many fine training programs out there.

Please help us understand why you selected
the Rutgers Tobacco Dependence Programs CCTS Training.

Please choose as many as apply
 Reputation of high-quality training
 Recommendation from colleagues
 Proximity to New York City/near other attractions
 Usual choice of your organization
 Ease of travel/proximity from your home
Other Reasons
Do you have a disability?
 Yes
 No

Home information


 

Home Address
Home City
Home State
Home Zip

The Tobacco Dependence Program at Rutgers is
asked by many including federal and local government agencies,

grantors and our own institution, to describe racial/ethnic backgrounds
of our training participants.

In order to respond to these requests, we ask you to answer the following questions.

Do you consider yourself to be Hispanic/Latino?
 Yes
 No

 In Addition, select one more of the following racial categories to describe yourself

Please choose as many as apply
 American Indian or Alaska Native
 Asian Black or African American
 Native Hawaiian or Pacific Islander
 White
 I do not wish to answer
 Other
If other please specify