REGISTRATION FORM

Lessons Learned: Innovative Approaches to Mental Health Courts and Related Services
Generating Hope in a Time of Scarce Resources

June 4, 2009, 7:45 a.m. to 3:45 p.m.
Location: College of DuPage Student Resource Center  (SRC) Room 2800, Glen Ellyn, Illinois
(for directions go to  http://www.cod.edu/Maps/)

Registration Fee $30 per person
Fees include continental breakfast, lunch, and  5.25 continuing education training credits.
For hotel information go to: http://hotel-guides.us/colleges/illinois/college-dupage.html

How to Register Online:
Complete this form online and click on the epay button,  enter the conference and credit card information, and pay your $30 fee.

How to Register by mail:
Save and print a copy of the completed registration form and include a check for  $30 payable to DuPage County Health Department and mail with registration to:
DuPage County Health Department, C/O Sandra Emory, 111 North County Farm Road, Wheaton, IL 60187

Confirmation of registration will be sent by fax or email.

 

 

Name(s):
Title(s):
Organization:
Address:
City:
State:
Zip Code:
Daytime Phone:
Fax:
E-mail address:
Comments:

Would you like to have your name and contact information included in a list of conference attendees that will be given to each registrant?
Yes
No

Would you like to attend a 5 – 10 minute demonstration experience of what a person with visual and auditory hallucinations would experience, using a simulator, during one of the breaks? (Capacity is limited)
Yes
No

Please designate which afternoon breakout session you would like to attend:
Breakout Session I: (select from the drop down menu below)

Breakout Session II: (select from the drop down menu below)

Check types of continuing education credits desired for 5.5 hours of training credit for the day:
LCSW/ LSW
LCPC/ LPC
Psychologist
IAODAPCA
MCLE
Certificate of Attendance

Cancellations must be by May 28, 2009 to receive a refund. For more information please contact Sandra Emory at the DuPage County Health Department, 630-682-7979, extension 7607 or email address Semory@dupagehealth.org

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