NYPP 2018 CONFERENCE REGISTRATION FORM REGISTRATION FORM FOR NYPP CONFERENCE - FRIDAY, APRIL 27, 2018 OK Question Title * 1. Conference Registration Fee is $20. Within 2-3 days you will receive a separate e-mail providing you with a link to pay your fee through Paypal. Your registration is not confirmed until we receive your payment. Name Organization (if none, write in “none” Email Address Phone Number OK Question Title * 2. Please re-enter your e-mail address OK Question Title * 3. Which of the following best categorizes your position at your organization Care/Case Manager Clinician/Therapist Mental Health Counselor Psychiatrist Nurse Practitioner Nurse (RN, LPN) Peer Specialist Substance Abuse Counselor Student/Intern Support Staff Clinical Director Program Manager Senior/Executive Staff Clinical Supervisor Other (please specify) OK Question Title * 4. Do you hold any of the following professional licenses or certifications? Check all that apply CASAC, CASAC-T CPRP Certified Peer Specialist Medical License APRN Registered Nurse Licensed Mental Health Counselor Licensed Clinical Social Worker Licensed Psychologist Licensed Practical Nurse Other (please specify) or None OK DONE