Registration:
NJPPC Mental Health Conference on April 2nd, 2025

PLEASE NOTE: We are only accepting registration for NJ pediatric primary care and specialty care providers along with their support staff at the NJPPC Mental Health Conference. A confirmation email will be sent to you upon review. Please email mhc@njaap.org with any questions.

We look forward to having NJ pediatric primary care and specialty care providers along with their support staff join us at the New Jersey Pediatric Psychiatry Collaborative (NJPPC) Mental Health Conference,

"Pediatric Depression & Suicidality in Primary Care". The event will be held at The Palace at Somerset Park (333 Davidson Ave, Somerset, NJ 08873) on Wednesday, April 2nd, 2025, from 7 am to 2 pm.

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* 1. Demographics

First Name *

Last Name *

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

Practice / Organization Name *

Practice County

Email Address *

Phone Number *

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

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

Attending

Resident

Other (please specify your position)

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

I am a NJPPC member

I am not a NJPPC member

Unsure if I am a NJPCC member

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* 5. What questions do you have for our presenters on the topic of Pediatric Depression & Suicidality in Primary Care?

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* 6. Are you a member of the New Jersey American Academy of Pediatrics (NJAAP)? Please note this is not referring to the National American Academy of Pediatrics membership.

Yes, I am a NJAAP member

No, I am not a NJAAP member

Unsure if I am a NJAAP member

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* 1. Demographics

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

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

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

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* 5. What questions do you have for our presenters on the topic of Pediatric Depression & Suicidality in Primary Care?

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* 6. Are you a member of the New Jersey American Academy of Pediatrics (NJAAP)? Please note this is not referring to the National American Academy of Pediatrics membership.

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