Alternatives 2018 Registration Form

Alternatives 2019 Conference Registration Form

Washington, D.C., July 7-11, 2019
Pre-conference: Sunday evening through Tuesday, 4 pm. A chance for people to prepare for, visit, and educate our Hill representatives.

Alternatives 2019 begins Tuesday evening with dinner and welcome keynotes and continues through Friday breakfast, July 12, 2019.
Name *

First Name Last Name
Name or nickname for Badge:
Group/Organization:

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone Number
Email *
example@example.com
Emergency Contact Name *

First Name Last Name
Relationship
Emergency Contact's Primary Phone Number *

Area Code Phone Number
Emergency Contact's Alternative Phone Number

Area Code Phone Number
Special Considerations: (must be requested by June 20, 2019 - disability/accessibility need, etc.) Note: Meals are buffet-style in the university dining hall. People can choose foods that meet their dietary needs. (Please be specific about accessibility needs):
Translation needs (ASL, Spanish):
Have you attended an Alternatives Conference previously? *

Yes No
Would you like to volunteer during the conference? If you check yes you will be contacted about volunteer opportunities. *

Yes No
T-Shirt Size: *
How do you identify? Please mark all that apply. (This section is completely voluntary). *

Mental Health Consumer/Survivor/Peer Lived experience of substance use/addiction Youth/Young adult Latinx Asian/Pacific Islander African American Native American/Alaska Native LGBTQ+ Veteran Person with disability (PWD) Person who has experienced homelessness MH Professional Family Member
Full Registration includes all meals. Please select only the events you WILL attend. You can only attend events that are included in your registration type.

Sunday Opening Dinner, July 7, 2019 Monday Meals, July 8, 2019 Tuesday Meals, July 9, 2019 Wednesday Meals, July 10, 2019 Thursday Meals, July 11, 2019 Friday Breakfast, July 12, 2018 All Meals
One-day Registration includes all sessions and three meals on one specific day. Indicate day below.
Refund Policy: Cancellations must be received in writing. If cancellation is requested on or before June 20, 2019 you will receive a full refund, minus a $35-per-person administration processing fee. After June 20, registrations will not be refunded. Registrants who are no-shows for the conference will not receive a refund.

Registrations submitted without payment or a purchase order from the sponsoring organization will not be processed. Payment or a PO is required for registration.

Conference Fee: Includes all workshops, plenary sessions, caucuses, and events. Overnight lodging is not included.
I plan to attend the Monday training and Tuesday Hill day

Yes No

Registration Options *

Full Registration Fee $ 345.00

One-Day Registration (Full price) $ 125.00

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Group or check registration:

Register 10 people and get a free registration? Email info@ncmhr.org if you would like to pay by check, email info@ncmhr.org for instructions. Or fax registration form to 978-681-6426. Are you interested in an exhibit space or caucus session? Apply at the website: www.alternatives-conference.org
Should be Empty:

Alternatives 2019 Conference Registration Form

Group or check registration: