Register by May 17th, and save $30.00 Registration Fee!

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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 Website NSGP Twitter NSGP Newsletter NSGP Email Announcement NSGP (large) Conference Postcard NSGP Facebook Page NSGP Full Conference Brochure Colleague/Friend AGPA Newsletter AGPA Website CGTA Print Ad MA Psych Assoc Web Ad MAPP Print Ad NASW Focus Print Ad NEPsy Print Ad Professional Listserve Invited as Ambassador Other (Please indicate other source in the box to the right)
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 click here to acknowledge agreement with statement above. Yes, I have read the statement above and consent to participate in groups
Program Selections				Select Rates Below
3-Day Saver Package (Save $ compared to 'a la carte' selections)	Includes ALL programs (please make selections below)	Includes All Programs except for Special Presentations (please make selections below)		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
	When Substance Abuse is an Issue: Maximizing Effectiveness of Group Psychotherapy
Special Presentation	Friday Night: Behavioral Couples Therapy + Tx Implications of the Self-Medication Hypothesis	Saturday AM: Moderation Training + Medication in Addctn Tx + Group for PTSD & Addctn	Sunday Afternoon: Clinical Case Applications w/ Vannicelli, Kueppenbender and Johnson	3 Days (Member): $115 3 Days (Non-Mem): $135 3 Days (Student): $65 1 Day (All Registrants): $45 2 Days (All Registrants): $90
Day-Long Experience 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
	If my choices above are either full or closed, please (select one):
	Assign me to a general psychodynamic group		Refund my Institute fee
	REDUCED FEE STANDBY OPTION: You may attend a Day-Long Experience Group for a reduced fee of $60 in return for agreeing to give the committee the flexibility to assign you to any Expereince group, as needed. 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 Experience Group, as necessary, to balance group 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 Experience Groups.  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)
Workshop (Sat AM)	1st Choice FD: Day-Long Workshop W-1: Jaeger W-2: Shay W-3: Furgeri W-4: Shields W-5: MacColl W-6: S. Cohen W-7: Kupnbnder & O'Neill	2nd Choice FD: Day-Long Workshop W-1: Jaeger W-2: Shay W-3: Furgeri W-4: Shields W-5: MacColl W-6: S. Cohen W-7: Kupnbnder & O'Neill	3rd Choice FD: Day-Long Workshop W-1: Jaeger W-2: Shay W-3: Furgeri W-4: Shields W-5: MacColl W-6: S. Cohen W-7: Kupnbnder & O'Neill	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-8: Barnes & Schwrtzbrg W-9: Counslmn & Rutan W-10: Levy W-11: Fanger & Lazarou W-12: Brnrd, Klein & Shrmr W-13: Ariam W-14: F. Weiss W-15: P. Cohen	2nd Choice W-8: Barnes & Schwrtzbrg W-9: Counslmn & Rutan W-10: Levy W-11: Fanger & Lazarou W-12: Brnrd, Klein & Shrmr W-13: Ariam W-14: F. Weiss W-15: P. Cohen	3rd Choice W-8: Barnes & Schwrtzbrg W-9: Counslmn & Rutan W-10: Levy W-11: Fanger & Lazarou W-12: Brnrd, Klein & Shrmr W-13: Ariam W-14: F. Weiss W-15: P. Cohen	Note: the Full-Day Workshop counts as two workshops (when choosing the fee).
Workshop (Sun AM)	1st Choice W-16: Jerram W-17: Anderson-Perales W-18: Silverstein W-19: Ben-Noam W-20: Hoekstra W-21: Ward W-22: Hegener	2nd Choice W-16: Jerram W-17: Anderson-Perales W-18: Silverstein W-19: Ben-Noam W-20: Hoekstra W-21: Ward W-22: Hegener	3rd Choice W-16: Jerram W-17: Anderson-Perales W-18: Silverstein W-19: Ben-Noam W-20: Hoekstra W-21: Ward W-22: Hegener
Demonstration Group	My Group, My Team, Myself: Team Athletics as a Mirror in Clinical Group Experience			Member: $80 Non-Member: $95 Student: $45
ADD UP fees in the right hand column and enter SUBTOTAL of PROGRAM FEES   >				* required
First-time Attendee Discount		First-time Attendees take 25% off Program Fees
SUBTRACT any discount and enter TOTAL PROGRAM FEES  >				* required
Registration Fee				$30.00 (after May 17th)
On-Site Lodging (Sign-up by 5/17/10)	Thursday Night	Friday Night	Saturday Night	ROOM RATES 1 Night Single Occupancy: $63 1 Ngt Sngl Occ., Priv. Bath: $70 2 Nights Single Occupancy: $126 2 Ngts Sngl Occ., Priv. Bath: $140 3 Nights Single Occupancy: $189 3 Ngts Sngl Occ., Priv. Bath: $210 1 Night Double Occupancy: $50 1 Ngt Dbl Occ., Priv. Bath: $58 2 Nights Double Occupancy: $100 2 Ngts Dbl Occ., Priv. Bath: $116 3 Nights Double Occupancy: $150 3 Ngts Dbl Occ., Priv. Bath: $174
ADD Registration Fee and any lodging costs to ENTER GRAND TOTAL   >				* required
Mailing Tickets: People registering by May 17th will receive their tickets in the mail. Tickets will be mailed by June 1st. People registering after May17th will pick up their tickets at the conference. Cancellation Policy: No refunds for cancellations after May 17th. 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 17th, 2010. 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 781-646-4468 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.