Please review the information below prior to completing your registration.

1. All Attendees will be provided the virtual log-in information. For accurate event center planning, please select in-person attendee, if you plan to join us in Bismarck for at least part of the conference.
2. Upon submitting this registration, you will be asked to provide payment via Paypal or a debit or credit card. Please have your form of payment ready as you cannot proceed with registration until payment information is entered.
3. A confirmation email will be sent for your registration and for your payment. Please confirm the accuracy of your email address on the registration page AND on the bottom of the payment screen.
4. 2nd Attempt - If you clicked “Next”, but didn’t complete the payment screen or received a confirmation email, please click here to follow the necessary steps to complete your registration.
5. To support the peer support workforce in North Dakota, we are offering a reduced conference rate for North Dakota Peer Support Specialists. Please fill out this application to determine eligibility for a reduced rate registration fee. If your application is approved the registration fee for the three-day conference will be $75 and you will receive an email with a one-time use discount code. Do NOT submit your registration without receiving a discount code (if applicable) as you will be charged the full amount.
6. If you have been provided a discount code, please confirm the amount that appears in green BEFORE clicking next. If you do not see the correct discount amount or receive an error (highlighted in red), do not proceed as you will pay the full amount. Contact Jill Walkinshaw Isaak for assistance with registration.

Attendee Registration

Registration TypePlease SelectGeneral Attendee $200University 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 $50HHS 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 $200University 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 $50HHS Team MembersSponsor Attendee PassND24 PMHCA - $200

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I plan on attending

In-Person

Virtually

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)

Yes

No

I am planning to attend a Pre-conference on Tuesday, September 17 from 8:00- 11:30am.

Yes

No

Which Pre-Conference are you planning on attending?

Pre-Conference #2: Ethics in Behavioral Health (Carmichael Finn)
(Click on the session title on the Agenda for more information)

Pre-Conference #3a and #3b: Mental Health: Breaking the Sigma and Supporting Children’s Mental Health (Gretchen Marsh)
(Click on the session title on the Agenda for more information)

I am planning to attend the part or all of the conference that begins at 1:00pm on Tuesday, September 17.

Yes

No

I am planning to attend the Networking Reception on Tuesday, September 17 from 4:45- 6:00pm.

Yes

No

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.)

Yes

No

First Name

Last Name

Email Address

Repeat Email Address

.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 ServicesNexus – PATHYouthworksUnaccompanied Refugee Minor (URM)

Please select the university you attend: Please select Dickinson State UniversityMayville State UniversityMinot State UniversityNorth Dakota State UniversityValley City State UniversityUniversity of JamestownUniversity of MaryUniversity of North DakotaOther

I am (please select all that apply)Administrator/BusinessCare CoordinatorClergyConsumer/Person in Recovery/Family MemberEducatorFamily Service SpecialistFirst Responder/Peace OfficerJuvenile ServicesLegal (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 TraineePeer Support SpecialistPhysician (MD/DO)Registered Nurse (RN)Other

If you are employed by a Human Service Zone, please indicate which office: Please select Agassiz ValleyBuffalo BridgesBurleighCassCentral PrairieDakota CentralEastern PlainsGrand ForksMountain LakesMountrail-McKenzieNorth StarNorthern PrairieNorthern ValleyRSRRoughrider NorthSouth CountrySouthwest DakotaThree RiversWard

If you are employed by Tribal Social Services, please indicate which office: Please select Spirit Lake NationStanding Rock Sioux NationThree Affiliated TribesTurtle Mountain Band of Chippewa

Please identify the Division/Section you work for: Please select AgingBehavioral HealthChildren and Family ServicesDevelopmental DisabilitiesExecutiveMedical ServiceVocational RehabilitationPublic HealthOther

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.

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