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2009 Convention Mail-In Registration Form
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2009 aPA CONVENTION & 

 CE WORKSHOP REGISTRATION

Name for Badge: ______________________________________________Degree: _______________________

Address: ____________________________________________________  Phone:________________________

City, State, Zip: _______________________________________________________________________

Fax Number:___________________E-mail__________________________________________________

Status:               Member        Non-Member          Student

 

I.    FULL CONVENTION PACKAGE:                                                                                $_________

      Members & Sister State Members:    $ 275.00         Non-Members: $325.00

The convention registration package includes registration fee, all workshops, continental breakfast on Saturday & Sunday, refreshment breaks, welcome reception and the annual meeting/awards luncheon (aPA members only).

 

DAILY INDIVIDUAL REGISTRATION: $25.00 Per Person Per Day (Student $10.00)  

        The individual registration includes a continental breakfast, refreshment breaks, welcome reception, and annual meeting/awards

        lunch (aPA members only) and Professional Affairs Breakfast

 

TO REGISTER FOR INDIVIDUAL WORKSHOPS YOU MUST PAY THE DAILY INDIVIDUAL REGISTRATION FEE LISTED BELOW.

 

Friday, June 12, 2009 - Daily Individual Registration Fee    (Student - $10.00)                  $          25.00

Workshop A: (9:00 – 12:00) Alzheimer’s and the Family                                                                             (if applicable)       

                -(3 C.E. Hours)  Member: $75.00   Non-Member: 90.00   Student: $10.00                                     $_________

Workshop B: (9:00 – 12:00) Psychological & Psycholosocial Assessment and Treatment Planning

                for the Chronically Ill Child: Use of the pediatric oncology population as an exemplar

                -(3 C.E.Hours)  Member: $75.00 Non-Member: $90.00   Student: $10.00                                     $_________

Workshop C: (2:00 – 5:00) Neuropsychology of Sports Concussion

                -(3 C.E.Hours) Member: $75.00 Non-Member: $90.00   Student: $10.00                                      $__________

Workshop D: (2:00 – 5:00) Identification of Autism Spectrum Disorders

                -(3 C.E. Hours)     Member:  $75.00   Non-Member: $90.00   Student: $10.00                                              $_________

 

Saturday, June 13, 2009 -  Daily Individual Registration      (Student $10.00)                                 $         25.00

Workshop E: (8:30– 4:30) The Ethics of Intimacy: The Cost of Caring Without Caring                        (if applicable)

                -(6 C.E. Hours) Member $150.00  Non-Member  $180.00  Student $20.00                                    $_________

                (Must attend both sessions to get C.E. Credits)                                                                           

 

Sunday, June 14, 2009 – Daily Individual Registration  (Student - $10.00)                          $         10.00

                                                                                                                                                    (if applicable)

(7:30 – 8:30)  Professional Affairs/Legislative/Board Forum Breakfast                                                  $     ­­­­        NC      

Workshop F: (9:00-12:00): Mental Health Services for Our Most Vulnerable Children & Families

                -(3 C.E. Hours) Member: $75.00  Non-Member: $90.00  Student: $10.00                                      $_________

 

                                                                                               

                                                                                                            TOTAL DUE aPA      $_________

 

(SELECT EACH WORKSHOP YOU PLAN TO ATTEND TO RESERVE SPACE)

 

 Enclosed is a check payable to aPA in the amount of    $_____________

 Charge my:    MasterCard    VISA #___________________________________Exp. Date__________

 Security Code___________               Signature:__________________________________

(Three digit number on back of your credit card)

      

 Please complete both sides of this form

Workshop Sign-Up

Please designate the workshops you plan to attend by circling the workshop letter on the day for which you are registered.  This information is used to determine the room size and seating arrangement for each session so as to provide a comfortable convention experience.  It will not be used to reserve seats in these sessions.

                                                  

Friday a.m.                                         9:00 – 12:00    Workshop A

            Friday a.m.                                         9:00 – 12:00    Workshop B

            Friday p.m.                                         1:30 – 4:30      Workshop C

            Friday p.m.                                         1:30 – 4:30      Workshop D

            Saturday a.m.                                     8:30 – 4:30      Workshop E

            Sunday a.m.                                        9:00 – 12:00    Workshop F               

           

Non-Workshop Events

Please designate the food events you plan to attend.  It is important that you indicate the events you will attend so ample food may be ordered.  Welcome Reception tickets for spouse, guest and children can be available for purchase at the Convention Registration Desk.

 

                       

          Friday (8:00): Continental Breakfast                           Yes    No

          Friday (4:30-5:30p) Annual Business Meeting             Yes    No

          Friday (6:00– 7:00): Welcome Reception                     Yes    No

          Saturday (8:00): Continental Breakfast                       Yes    No

          Saturday (12:00-1:30):  Awards Luncheon                   Yes    No

          Saturday (5:00-7:00): ALPA Meeting                           Yes    No

          Sunday (7:30-8:30): Professional Affairs Breakfast    Yes    No

          Sunday (8:00):  Continental Breakfast                         Yes    No

                  

          MAIL TO:                   Alabama Psychological Association

                                                P. O. Box 97

                                                Montgomery, AL 36101-0097

                                                Telephone:  334/262/8245   -   execdir08@bellsouth.net

 

 

 

 

 

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Alabama Psychological Association
P. O. Box 97
Montgomery, AL 36101
Phone: 334-262-8245
Fax: 334-460-8330