MHP Conference 2023 approved Registration - Agudath Israel of America

Registration Info

This form is for conference registration only. Registration for the conference DOES NOT include overnight lodging. If you wish to stay overnight at the Armon Hotel, you must book hotel reservations separately using this link.

Due to space limitations, we are unable to accept registrations from those who are not currently working in the mental health field (e.g. students, spouses). If you are a student/spouse and would like to be added to the conference waitlist, please reach out to us at [email protected]. Spouses are welcome to register for hotel and meals, via the hotel link above.

Mental Heath Track

Price:

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Home Phone Number

Cell Phone Number*

Professional Background

Highest Degree Earned*

Other*

School Attended*

What is the setting of your practice?*

Check all that apply

School

Agency

Private

Other

Other*

Where is the location of your practice?*

What is the name of your practice setting (if applicable)?

What population do you work with?*

Check all that apply.

Children

Adolescents

Adults

Geriatric

Couples

Other

For our journal bios, please provide a paragraph description of your professional work including therapeutic orientation and any specialties you wish to share.*

Example: Chana Cohen LCSW, is a therapist in private practice, with a CBT orientation. She works primarily with anxiety and depression. Additionally, Ms. Cohen works in schools providing treatment to children.

Payment Information

Billing Address*

Street Address Address Line 2 City State ZIP Code

Credit Card*

American Express

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MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Full Name

Total

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Coupon

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Coupon Code

Cancellation Policy

Full refunds until 2 weeks prior to the event; 50% thereafter; cancellations made within 48 hours of the conference are not refunded.

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