Thursday, November 2 & Friday, November 3, 2017
Sinclair Conference Center (Building 12)

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* First Name:

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* Last Name:

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* Job Title:

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* Organization:

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* Email Address:

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* Phone Number:

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* Which breakout session will you be attending? (Choose One)

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* Free Box Lunch Option (Choose One)

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* Do you have a professional licensure for which you would like to receive CEUs?

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* Narcan training is available, and those who attend will receive a kit upon class completion. To register for the Narcan training, please select the time at which you will be attending:

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* Are you interested in attending the Master Class?
(Note: the Master Class begins on Thursday afternoon and is all day Friday.)

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* The Master Class enrollment will be limited to 50 participants and admission to this class will be competitive in the event that interest exceeds capacity. Please provide a brief summary of why you’re interested in attending the Master Class including any addiction related experience, as well as any experience you may have with storytelling via journaling, writing, film making, etc..

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