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EVENT REGISTRATION
Creating a Narrative for Change: The Opioid Crisis
Thursday, November 2 & Friday, November 3, 2017
Sinclair Conference Center (Building 12)
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First Name:
(Required.)
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Last Name:
(Required.)
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Job Title:
(Required.)
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Organization:
(Required.)
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Email Address:
(Required.)
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Phone Number:
(Required.)
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Which breakout session will you be attending? (Choose One)
(Required.)
The Policy of Addiction
First Responders and Social Services
Caregivers
Free Box Lunch Option (Choose One)
Turkey Club Sandwich
Ham & Swiss Sandwich
Grilled Chicken Salad
(with gluten-free dressing)
Greek Salad with Portobello Mushroom
(with gluten-free dressing)
Do you have a professional licensure for which you would like to receive CEUs?
Yes
No
If Yes, please specify:
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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:
(Required.)
AM Session - 8:30 - 9:15AM
PM Session - 2:30 - 3:15PM
Not Interested
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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.)
(Required.)
Yes
No
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..