Evaluation – Consensual Non-monogamy with Dr. Theodore Burnes and Dr. Michelle D Vaughan "*" indicates required fields Your Email Address*Please provide the email address you registered with for this presentation. Enter Email Confirm Email Name*Please provide your name as you would like to see it displayed on your certificate. Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Are you licensed and submitting this form for CEU(s)?* Yes, please issue my CEU(s) No, I'm just submitting an evaluation Note that we can issue CEUs to California-licensed LPCCs, LMFTs, LCSWs and LEPs only. We are not certified to issue CEUs to prelicensed associates or students. License Type(s)* LPCC LMFT LCSW LEP An accepted license type is required in order for us to issue CEU credits. License Number(s)* Valid license numbers are manditory in order for us to issue CEU credits. Please rate the presentation, with “1” being low and “5” being highThe presenter(s) clearly presented the subject matter.*12345The presenter(s) knew the subject matter.*12345Materials, handouts, slides, etc., were useful.*12345The level of information was appropriate for the audience.*12345The presentation met the goals and objectives outlined in the description.*12345Overall rating for this presentation.*12345Recommendation for this presenter(s) for future CALPCC events.*12345Additional Comments:Your Digital Signature (Please type your name)*I understand that digitally signed documents are just as legally binding as signatures on paper, and I agree to be legally bound by this digital signature. By entering my name below, I attest that I attended this presentation, and that the responses on this evaluation form are my own. NameThis field is for validation purposes and should be left unchanged.