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Ambassador Program	Check here if you were invited to attend the conference as a member of our Ambassador Program.
How did you learn about the conference?	Previously attended NSGP email announcement NSGP conference postcard (large) NSGP full conference brochure NSGP website NSGP Newsletter NSGP Facebook page Colleague or Friend AGPA website AGPA Newsletter NEPsy print ad MA Psych Assoc web ad NASW Focus print ad CGTA print ad MAPP print ad Professional Listserve Twitter Invited as Ambassador Other
Membership Status	Member New Member Non-Member
Student Status	Fulltime Student NSGP Training Program Student
Is this your first NSGP Conference?	Yes, this is my first conference No, this is not my first conference
Professional Discipline	Alcoholism/Substance Abuse Counselor Clinical Nurse Specialist Mental Health Counselor Pastoral Counselor Physician Psychologist Social Worker Other
No. of Years of Group Therapy Experience	0 - 2 3 - 7 8 - 14 15 or more
Participation Agreement	Effective group therapy training is best facilitated by both participation in a group led by experts and study of the resulting group process. While NSGP provides training groups rather than therapy groups, the experience can lead to difficult or uncomfortable feelings in the participants. Because they involve group participation, you should not register for Institutes or volunteer for the Demonstration Group if you prefer to avoid this risk. By registering or volunteering you acknowledge that you have been informed of this risk and consent to participate. Please confirm your agreement by clicking here Yes, I have read the statement above and consent to participate.
Program Selections				Select Rates Below
Registration Fee	Register by May17th and subtract Registration Fee below (in discounts sections).			SELECT FEE By 5/18/09: No Fee After 5/18/09: $30
3-Day Package	Includes All Programs	Includes All Programs except for Special Presentation		All Programs (Member): $450 All Programs (Non-Mem): $535 All Programs (Student): $220 All but Spec Pres (Member): $340 All but Spec Pres (Non-Mem): $430 All but Spec Pres (Student): $185
CGP Program	Certificate of Group Psychotherapy Program (Includes 4 Sessions & Demonstration Group)			Member: $190 Non-Member: $245 Student: $110
CGP Program + Institute/Exp.Group	Certificate of Group Psychotherapy Program + Institute/Experiential Group			Member: $320 Non-Member: $410 Student: $180
Special Presentation TBA	Friday Night	Saturday Morning	Sunday Afternoon	3 Days (Member): $115 3 Days (Non-Mem): $135 3 Days (Student): $65 1 Day (All Registrants): $45 2 Days (All Registrants): $90
Institute/Experiential Group	1st Choice I-1: Metz I-2: Starr I-3: Levine I-4: Haut I-5: A. Cohen & Emerson I-6: Cadwell & Collier I-7: Kramer Slepian I-8: Hecht I-9: Juravleva I-10: Moore I-11: Rutan I-12: Weber & Kehoe I-13: Papernow	2nd Choice I-1: Metz I-2: Starr I-3: Levine I-4: Haut I-5: A. Cohen & Emerson I-6: Cadwell & Collier I-7: Kramer Slepian I-8: Hecht I-9: Juravleva I-10: Moore I-11: Rutan I-12: Weber & Kehoe I-13: Papernow	3rd Choice I-1: Metz I-2: Starr I-3: Levine I-4: Haut I-5: A. Cohen & Emerson I-6: Cadwell & Collier I-7: Kramer Slepian I-8: Hecht I-9: Juravleva I-10: Moore I-11: Rutan I-12: Weber & Kehoe I-13: Papernow	Member: $130 Non-Member: $165 Student: $70 Standby Option: $60
	REDUCED FEE STANDBY OPTION: You may attend an Institute for a very reduced fee of $60 in return for agreeing to give the committee the flexibility to assign you to an Institute. You may indicate your first, second and third choices above. When possible we will honor your preferences. However, the committee may assign you to another Institute, if necessary, to balance Institute membership. You will be informed of your assignment when you pick up your tickets. If we cannot accommodate you for this standby option, you will have the option to pay the regular fee and choose among the available Institutes.  This offer is available on a first-come, first-served basis for up to 10 people. Standby Option (make three choices above, which we may honor)
If choices 1-3 are unavailable (check one):	Assign me to a general psychodynamic group		Refund my Institute fee
Workshop (Sat AM)	1st Choice W-1: Jaeger W-2: Shay W-3: Furgeri W-4: Shields W-5: MacColl W-6: S. Cohen W-7: Kupnbnder & O'Neill W-8: Hollander W-9: P. Cohen W-10: Kramer Slepian	2nd Choice W-1: Jaeger W-2: Shay W-3: Furgeri W-4: Shields W-5: MacColl W-6: S. Cohen W-7: Kupnbnder & O'Neill W-8: Hollander W-9: P. Cohen W-10: Kramer Slepian	3rd Choice W-1: Jaeger W-2: Shay W-3: Furgeri W-4: Shields W-5: MacColl W-6: S. Cohen W-7: Kupnbnder & O'Neill W-8: Hollander W-9: P. Cohen W-10: Kramer Slepian	1 Wrkshp (Member): $70 1 Wrkshp (Non-Member): $85 1 Wrkshp (Student): $45 2 Wrkshps (Member): $130 2 Wrkshps (Non-Mem): $155 2 Wrkshps (Student): $65 3 Wrkshps (Member): $180 3 Wrkshps (Non-Mem): $220 3 Wrkshps (Student): $90 3 Wrkshps+Demo (Member): $230 3 Wrkshps+Demo (Non-Mem): $285 3 Wrkshps+Demo (Student): $120
Workshop (Sat PM)	1st Choice W-9: Ward W-10: Gaskill W-11: Sorensen W-12: Shields W-13: Juravleva W-14: Russell W-15: Kuppnbndr & Pupolo W-16: Counselman	2nd Choice W-9: Ward W-10: Gaskill W-11: Sorensen W-12: Shields W-13: Juravleva W-14: Russell W-15: Kuppnbndr & Pupolo W-16: Counselman	3rd Choice W-9: Ward W-10: Gaskill W-11: Sorensen W-12: Shields W-13: Juravleva W-14: Russell W-15: Kuppnbndr & Pupolo W-16: Counselman
Workshop (Sun AM)	1st Choice W-17: Altfeld & Gans W-18: Chilenski W-19: Hoekstra W-20: Furgeri W-21: James W-22: Silverstein W-23: Shwrtzbrg & Barnes W-24: Anderson-Perales	2nd Choice W-17: Altfeld & Gans W-18: Chilenski W-19: Hoekstra W-20: Furgeri W-21: James W-22: Silverstein W-23: Shwrtzbrg & Barnes W-24: Anderson-Perales	3rd Choice W-17: Altfeld & Gans W-18: Chilenski W-19: Hoekstra W-20: Furgeri W-21: James W-22: Silverstein W-23: Shwrtzbrg & Barnes W-24: Anderson-Perales
Demonstration Group	Augmenting the Restoration of Attachment After Trauma			Member: $80 Non-Member: $95 Student: $45
Add up choices in the right hand column and ENTER SUBTOTAL of PROGRAM FEES				* required
Calculate Discounts (if any)	10% Off: Three or more Registrants from one agency Three Workshops for the price of two for 1st time attendees 25% Off: Bring a first time attendee
Subtract any discounts and ENTER TOTAL PROGRAM FEES				* required
On-Site Lodging (Sign-up by 5/18/09)	Thursday Night	Friday Night	Saturday Night	ROOM RATES 1 Night Single Occupancy: $62 2 Nights Single Occupancy: $124 3 Nights Single Occupancy: $186 1 Night Double Occupancy: $48 2 Nights Double Occupancy: $96 3 Nights Double Occupancy: $144
Add any lodging and ENTER GRAND TOTAL				* required
Mailing Tickets: People registering by May 18th will receive their tickets in the mail. Tickets will be mailed by June 1st. People registering after May18th will pick up their tickets at the conference. Cancellation Policy: No refunds for cancellations after May 18th. Cancellations require written notification.		NSGP Member Rates are available only to those whose membership is in effect or those who have applied for membership by May 18th, 2009. Student Discount applies to full time students only. Need Help? Because of the many conference choices, registering can be confusing. For questions about the conference structure, call or email Joe DeAngelis at 978-851-4468 or joe.deangelis.licsw@gmail.com.		BEFORE hitting the Submit button below, please WRITE DOWN your GRAND TOTAL. You will need to enter this on the payment page.