Annual Conference 2024 Registration I am submitting this form for:(Required) Myself Another individual Email of Submitter(Required) Please enter your own email address.Is the attendee a member of NAMI Vermont?(Required) Yes No Membership status will be confirmed after registration. If you are unsure whether you are a current NAMI Vermont member, call 802-876-7949 x100.Is this registration pre-paid by an organization/group? (Only choose 'yes' if your organization has already paid and sent you this registration form to sign up)(Required) Yes No Which organization are you affiliated with?(Required) Cost for Members Price: Cost for Non-members Price: Attendee's Name(Required) First Last Attendee's Pronouns(Required) Attendee's Organization/Affiliation Attendee's Email Address(Required) Attendee's Phone Number(Required)Attendee's Mailing Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Which morning workshop would you like to attend?(Required) David Melnick: Workshop #1 – Transforming Trauma: How our Organizations Help to Heal (part 1) Scott Bushey: LGBTQ+ Mental Health Experiences Panel Corrina Thurston: From Darkness to Color: Corrina’s Journey of Resilience, Art, and Self-Healing Please choose one. Visit namivt.org/conference-2024 for descriptions of each workshop and presenter.Which early afternoon workshop would you like to attend?(Required) Anne Bilodeau & Kate Lamphere: HCRS Leads Statewide Mobile Crisis Program Helen J. Wood: Coordinated Specialty Care for First Episode Psychosis Cristina Maddocks: Umatter® Suicide Prevention Awareness Overview Please choose one. Visit namivt.org/conference-2024 for descriptions of each workshop and presenter.Which late afternoon workshop would you like to attend?(Required) Kristina Petter: Shared Strength: Insights from Family and Peer Mental Health Support Groups Panel David Melnick: Workshop #2 – Transforming Trauma: How our Organizations Help to Heal (part 2) Alexis Brieant: Adversity and the Developing Brain: Implications for Youth Mental Health and Well-Being Please choose one. Visit namivt.org/conference-2024 for descriptions of each workshop and presenter.Are you (or the attendee) requesting CEUs (Continuing Education Units) for this conference?(Required) No Yes—I would like CEUs as a Licensed Clinical Mental Health Counselor Yes—I would like CEUs as a Social Worker Yes—I would like CEUs as a Recovery Coach (Certified or Seeking Certification) Last 4 Digits of Social Security Number(Required)Please enter a number from 0000 to 9999.This identification is required for us to process your CEUs as a Licensed Clinical Mental Health Counselor.NASW ID Number(Required)This identification is required for us to process your CEUs as a Social Worker.Total How would you like to pay for this registration?(Required) Credit Card (via PayPal) Mail a check If you choose pay by check, your registration will not be confirmed until we have received the payment.Will you (or the attendee) need any accommodations? If so, please describe them. I would like to receive the NAMI Vermont biweekly e-newsletter. Yes Payment Method(Required)PayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged.
