Registration Type Please Select General Attendee $200 University Students $50 (.edu email address is required) Peer Support Scholarship $200 (See above for link to application for discount) Foster Care Provider (family homes)/Adoptive Parent/Kinship Provider $50 HHS Team Members (see email from your division leader for a discount code) PMHCA (See email for discount code) Sponsor Attendee Pass (Access code required)
Packages Select Package General Attendee $200 University Students $50 (.edu email address is required) Peer Support Scholarship $200 (See above for link to application for discount) Foster Care Provider/Adoptive Parent/Kinship Provider $50 HHS Team Members ND24 PMHCA - $200 0.0
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Payment Section Select Payment Method Stripe (Stripe)
Please indicate below if you are attending the following events (all included with your registration fee at no extra cost):
I am planning to attend the Supervision Pre-conference (Carmichael Finn) on Monday, September 16 from 1:00- 4:30pm. (Click on the session title on the Agenda for more information) I am planning to attend a Pre-conference on Tuesday, September 17 from 8:00- 11:30am. Which Pre-Conference are you planning on attending? I am planning to attend the part or all of the conference that begins at 1:00pm on Tuesday, September 17. I am planning to attend the Networking Reception on Tuesday, September 17 from 4:45- 6:00pm. I am planning to partake in the Lunch on Thursday, September 19 from 11:45am- 1:00pm. (Note: Lunch will be on your own Tuesday and Wednesday.) First Name
Last Name
.edu address is required*
Please verify email address to ensure you receive all conference updates.
Mobile
Company
Zip Code
Title
Emergency Contact Name
Emergency Contact Phone Number
For Foster Parents Only: Please indicate which authorized licensing agent you are affiliated with: Please select HHS/State (previously County/Human Service Zone) Tribal Social Services Nexus – PATH Youthworks Unaccompanied Refugee Minor (URM)
Please select the university you attend: Please select Dickinson State University Mayville State University Minot State University North Dakota State University Valley City State University University of Jamestown University of Mary University of North Dakota Other
I am (please select all that apply) Administrator/Business Care Coordinator Clergy Consumer/Person in Recovery/Family Member Educator Family Service Specialist First Responder/Peace Officer Juvenile Services Legal (eg: attorney, juvenile court officer, judge, etc.) Licensed Addiction Counselor (LAC) Licensed Marriage and Family Therapist (LMFT) Licensed Professional Counselor (LPC, LPCC) Licensed Psychologist (LP) Licensed Social Worker (LBSW, LMSW & LCSW) NDBACE Clinical Training Program Trainee Peer Support Specialist Physician (MD/DO) Registered Nurse (RN) Other
If you are employed by a Human Service Zone, please indicate which office: Please select Agassiz Valley Buffalo Bridges Burleigh Cass Central Prairie Dakota Central Eastern Plains Grand Forks Mountain Lakes Mountrail-McKenzie North Star Northern Prairie Northern Valley RSR Roughrider North South Country Southwest Dakota Three Rivers Ward
If you are employed by Tribal Social Services, please indicate which office: Please select Spirit Lake Nation Standing Rock Sioux Nation Three Affiliated Tribes Turtle Mountain Band of Chippewa
Please identify the Division/Section you work for: Please select Aging Behavioral Health Children and Family Services Developmental Disabilities Executive Medical Service Vocational Rehabilitation Public Health Other
If you are unable to pay using either of the provided options, please contact dhsbhd@nd.gov to register and complete the payment process. Please review all information above as it will be used for check-in and name badge printing.