We look forward to you joining us at the New Jersey Pediatric Psychiatry Collaborative (NJPPC) Atlantic Health Regional Dinner and CME Presentation, "Eating Disorders vs Disordered Eating: Identifying the Difference, Preventing Progression, and Supporting Treatment" with Dr. Jason Minion. The event will be held at Maggiano's Little Italy in Bridgewater (600 Commons Way Bldg. E, Bridgewater, NJ 08807) on September 17, 2025 from 5pm to 8pm. Free Parking is available. Additional details to follow.

OK

*1.Demographics(Required.)

First Name

Last Name

Credentials (MD, DO, APN, PA, etc.)

Practice/Organization Name

Practice County

Email Address 

Phone Number

*2.NPI Number (if not applicable, please write "NA")(Required.)

*3.Please indicate if you are an attending or a medical resident at your practice:(Required.)

Attending

Resident

Other (please specify your position)

*4.Are you a member of the New Jersey Pediatric Psychiatry Collaborative (NJPPC)?(Required.)

I am a NJPPC member

I am not a NJPPC member 

Unsure if I am a NJPCC

*5.Are you a member of the New Jersey Chapter of the American Academy of Pediatrics? (Please note, this is a separate membership from the national American Academy of Pediatrics)(Required.)

I am an NJAAP member

I am not an NJAAP member

Unsure if I am an NJAAP

6.What questions do you have for our presenter on eating disorders and/or disordered eating?

7.Do you have any questions for our Physician Champion on how they integrate mental health care and/or work with the NJPPC in their practice?

*8.Do you require a Kosher meal? (Please note that a Kosher meal will be ordered for you if you indicate ‘yes’ for this field and a member of our team will follow-up to confirm.)(Required.)

Yes

No

9.Do you require any special accommodations or is there anything else you would like us to know (e.g., food allergies)?