Sponsorship

Sponsorship Form

Name of Sponsor / Organization:*

Address:

Street Address

Street Address Line 2

CityState

Zip Code

Contact Name:*

Phone Number:*

E-mail:*

Registration Information:
Included in your sponsorship is one free registration to attend the institute. If you are a co-host, included in your sponsorship is two free registrations. Co-hosts will need to email LGPS with the name of their second attendee. Please identify the name of the attendee who will be attending the institute, and whether or not they would like to participate in experiential groups.

Please note that once registration is submitted, changes to the registered attendee(s) are allowed. However, if the initial attendee was registered to participate in experiential groups, the replacement attendee must also participate in the experiential groups. If the initial attendee was not registered for experiential groups, the replacement attendee will not be able to participate in experiential groups.

We kindly request a firm commitment on whether the attendee(s) will participate in experiential groups at the time of registration to ensure accurate planning.

Requirements for Receiving CEUs:
- Attendance for the full institute
- Participation in all small group sessions (Fall & Spring only)
- Completion of an institute evaluation form

Cancellations must be submitted in writing and received three days prior to the institute. An administrative fee of 50% of the registration cost will be deducted.

COVID Precautions: To ensure a safe environment for all attendees, LGPS follows Centers for Disease Control and Prevention (CDC) guidelines. We respectfully ask that any individuals displaying symptoms within 72 hours of the event to consider refraining from attending or implementing additional precautionary measures.

Photography: LGPS may utilize photos from events for promotional and marketing purposes. If you have any concerns regarding the use of your image, please do not hesitate to contact LGPS.

Review the Guidelines for Participants for additional information.

Attendee Name & Credentials:*

Attendee E-mail Address:

Participation in Experiential Groups:

The attendee listed above would like to participate in experiential groups. (Please read participation requirements above)

Please choose your first, second, and third preferences for your experiential leader during small groups. We will try out best to accommodate your selection. The sooner you register, the better chance you have of getting your first choice.

2024 Spring Institute Experiential Group Leader Preference (Attendee #1):

	1st	2nd	3rd
Jonathan Breaux, LCSW, CGP
Jason Crooks, LCSW
Christen Cummins, LCSW-BACS
Kirsten Dantin, LPC-A, CCTP, NCC
Hanna Tadevich, LPC
Jessica Gibson, LPC-S
Elizabeth "Libby" Knox, LPC

Requirements for Receiving CEUs:
- Attendance for the full institute
- Participation in all small group sessions (Fall & Spring only)
- Completion of an institute evaluation form

Cancellations must be submitted in writing and received three days prior to the institute. An administrative fee of 50% of the registration cost will be deducted.

COVID Precautions: To ensure a safe environment for all attendees, LGPS follows Centers for Disease Control and Prevention (CDC) guidelines. We respectfully ask that any individuals displaying symptoms within 72 hours of the event to consider refraining from attending or implementing additional precautionary measures.

Photography: LGPS may utilize photos from events for promotional and marketing purposes. If you have any concerns regarding the use of your image, please do not hesitate to contact LGPS.

Review the Guidelines for Participants for additional information.

By typing my name in the box below, I acknowledge that in order to obtain CEUs, the individuals attending on behalf of this organization will be required to attend the entire conference, participate in all of the small groups (Fall & Spring only), and that partial CEUs will not be offered.*

By typing my name in the box below, I acknowledge that participation in the experiential groups may bring up uncomfortable or unwanted feelings. I agree to participate at my own risk and will notify an LGPS board member immediately if I need assistance.*

Select Event & Level of Sponsorship:

Spring Institute - Co-Host$1,500

Spring Institute - Sponsor$850

Fall Institute - Co-Host$900

Fall Institute - Sponsor$500

Winter Workshop - Sponsor$250

Summer Workshop - Sponsor$250

I will send a check in the mail to LGPS PO Box 83005 Baton Rouge, LA 70884*Please indicate which event you are registering for on the check $ Free

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