Registration – Missouri Department of Mental Health’s Spring Training Institute 2012

Please fill out the form below. A confirmation with further information will be sent upon receipt of your payment.

or use this STI Printable Registration Form (right-click and choose save-as)

The Early Registration fee of $165 for the full program and $85 for one day is in effect until April 20, 2012.

All participants will receive an electronic version of handouts at the program. A printed version is available for $25.

Conf:
Price: *	$165 full program $85 Thursday only $85 Friday only $190 full program with printed handout $110 Thursday only with printed handout $110 Friday only with printed handout
Location*	Thursday, May 31 and Friday, June 1, 2012 at Tan-Tar-A, Osage Beach, MO
Payment Options *	Credit Card Bill My Employer
Name *
Address *
City *
State *
Zip *
Email Address *
Daytime Phone *
Profession
Degree
Employer *
Work Address *
Work City *
Work State *
Work Zip *
Work Phone *
Purchase Order Number *
Fiscal Contact’s Name
Fiscal Contact’s Phone

* = required fields

* = required field only when paying by invoice

If paying by credit card (Visa or MasterCard only), you will be forwarded to the University of Missouri’s QuikPay system in order to enter card information.

If paying by invoice, we will send your conference registration upon receipt of a hard copy of your purchase order.

Cancellations or Substitutions:

If you are unable to attend, we ask that you notify us as soon as possible. Cancellations received in writing five business days prior to the date of the program will be refunded, less a $25.00 processing fee. You may send a substitute, but we ask that you notify us in writing of this change. If you do not attend or send a substitute, you or your employer will be billed the full registration fee.

or use this STI Printable Registration Form (right-click and choose save-as)

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Registration – Missouri Department of Mental Health’s Spring Training Institute 2012

Registration – Missouri Department of Mental Health’s Spring Training Institute 2012

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