UCLA ISAP In-Person Registration Form

Effecting Change Through the Use of Motivational Interviewing: INTRODUCTION to MI Training

Registration Form

Date: Wednesday, April 2, 2025

Time: 9:00am-12:30pm HST (Check in begins at 8:30am)

Trainer: Grant Hovik, MA

Location:

Maui College Pilina Events Center

310 W Kaahumanu Ave, Kahului, HI 96732

Motivational interviewing, a treatment approach developed by William Miller, has been well established as an effective way to promote behavior change in individuals. Please see the flyer for more details.

Please contact Brandy Oeser by e-mail (boeser@mednet.ucla.edu) if you have questions, special needs, or require additional information prior to completing the registration form.

Capacity for this in person training is 40. Please make sure you receive a confirmation email before attending.

First Name

Last Name

Agency Name

Email Address

Mailing Address (Include City and State)

Phone Number

License or Certificate Number ***License number is required for psychologists and registered nurses (write N/A if not seeking CE):

Special Needs or Other Accommodations: