Preparing for a Changing Health and Behavioral Healthcare System:

Cultivating Knowledge and Skills to Meet the Challenge

Wednesday December 5, 2012: 9:00 am - 4:30 pm

(Starred items (*) are required.)

Billing Information:

* First Name/Last Name:

* Address:

* City/State/Postal Code:

* Country:

Registrant Information:

* First Name/Last Name:

* Email:

* Confirm Email:

* Phone:

Agency:

Title:

* Certification/Licenses:
Other:

* Highest Degree:
Other:

* Rates (discounts cannot be combined):

(proof of any alumni/academic affiliation required at event check-in)

Please email Stephanie Kaplan for group discounts, co-sponsor rates and other specific considerations.

Please choose one (different) workshop for each of the sessions.

* Workshop 1 Choice (morning)

* Workshop 2 Choice (afternoon)

Describe any special needs that require accommodations:

Once your registration form has been received, you will be notified via email. Please note that payment is required for full registration. You will receive notice of full registration upon receipt of payment.