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2023 Kansas Recovery Conference - Individual Registration
"Honoring Our Past, Building Our Future"
This page is to register as an attendee for the 2023 Kansas Recovery Conference
*
1.
Attendee Information
(Required.)
Name
*
Organization
Address
*
Address
City/Town
*
State
*
ZIP
*
Email Address
Phone Number
*
*
2.
Registration Type (Please select one)
(Required.)
Consumer, Early Bird - $110 / $120 after May 5th
Non-Consumer, Early Bird - $150 / $160 after May 5th
A commemorative t-shirt is NOT included with your registration. T-shirts may be purchased for $15 / each.
3.
Yes, I would like to order a commemorative conference t-shirt (Please select the size you will need)
Small - $15
Medium - $15
Large - $15
X-Large - $15
2X - $15
3X - $15
4X - $15
5X - $15
Comments
*
4.
Conference Meals
- Please check the meals/dates you will be present for. The cost of meals are included with the conference registration.
(Required.)
Tuesday, June 6th - Lunch
Tuesday, June 6th - Dinner
Wednesday, June 7th - Lunch
None of the Above
5.
Food Allergies / Special Dietary Requirements
--
please list any additional special requirements you have below (i.e. allergies, vegetarian or vegan meals, etc— please note if the request is due to a food allergy)
The CAC will make every effort to accommodate reasonable special requirements/requests but cannot guarantee accommodations
6.
Please mark this box if you will be bringing a service animal to the conference
Yes, I am bringing a service animal to the conference
*
7.
Payment Method
(Required.)
Check
Debit/Credit Card
Money Order
Other (please specify)
Please mail checks and money orders to
Kansas CAC
PO Box 56
Wichita, KS 67201
If you will be paying with a debit or credit card, please click on the following link for the:
Kansas CAC Conference payment (a new window will open up in your browser)
Special Accommodations
If you wish to volunteer information regarding any special assistance you may need, please contact Melissa Patrick at (316) 312-3479.
Notice of Nondiscrimination
The Kansas Consumer Advisory Council for Adult Mental Health, Inc. does not discriminate in its programs and activities on the basis of race, religion, color, national origin, gender, age, sexual orientation, marital status, political affiliation, status as a veteran, genetic information or disability. The following person has been designated to handle inquiries regarding nondiscrimination policies: Melissa Patrick, (316) 312.3479.
