Conference Registration: Pay by Check HiddenReference Number First Name* Last Name* Email* Phone*Name of your employer / non profit organization / school or school district* What is your professional title?* If you are seeking Continuing Education Credits, please indicate your professional affiliation* Do you have any dietary restrictions* Conference on Suicide: Advocacy in Action Registration Options: There are a number of registration options available for the Advocacy in Action Conference and the School Summit. Advocacy in Action Conference Registration Options The 3 Day and 2 Day Ticket options (Tickets A and B) are for the Advocacy in Action Conference program ONLY and do not include the Thursday School Summit program. Tickets C and D are single day admission for the Advocacy in Action Conference on Thursday or Friday ONLY. Ticket E is for the Saturday Survivor Program ONLY. Ticket FS is a 2 Day Ticket for Friday Advocacy in Action Conference and Saturday Survivor Program that can be selected in addition to the 1 Day Thursday School Summit Ticket SS or as a separate, stand-alone purchase. School Summit Registration Options The School Summit runs concurrently with the Advocacy in Action Thursday Conference. Some of the Plenary Sessions will be presented jointly to attendees of both the School Summit and the Advocacy in Action Conference. If you wish to attend the Thursday School Summit ONLY, you should select the 1 Day Thursday School Summit Ticket SS. If you wish to return on Friday or Saturday, you can add the 1 Day Friday Advocacy in Action Conference Ticket D or the 1 Day Saturday Survivor Program Ticket E by selecting those tickets in addition to the Thursday School Summit ticket. If you wish to attend the School Summit and both the Friday Advocacy in Action Conference and the Saturday Survivor Program, you may select Ticket FS in addition to the Thursday School Summit Ticket SS. Advocacy in Action Conference Tickets Ticket A Quantity3 Day Advocacy in Action Conference (BEST VALUE) Includes the Thursday and Friday Advocacy in Action Conference and the Saturday Survivor Program Price: $250.00 Quantity HiddenTicket A: Attendee DetailsPlease enter the Name and Emails of each attendee for this ticketHiddenFull Name HiddenAddress HiddenEmail HiddenProf Title HiddenEmployer/Organization Ticket B Quantity2 Day Advocacy in Action Conference Includes the Thursday and Friday Advocacy in Action Conference Price: $200.00 Quantity HiddenTicket B: Attendee DetailsPlease enter the Name and Emails of each attendee for this ticketHiddenFull Name HiddenAddress HiddenEmail HiddenProf Title HiddenEmployer/Organization Ticket C Quantity1 Day Thursday Advocacy in Action Only Conference Price: $100.00 Quantity HiddenTicket C: Attendee DetailsPlease enter the Name and Emails of each attendee for this ticketHiddenFull Name HiddenAddress HiddenEmail HiddenProf Title HiddenEmployer/Organization Ticket D Quantity1 DAY Friday Advocacy in Action Only Conference Price: $100.00 Quantity HiddenTicket D: Attendee DetailsPlease enter the Name and Emails of each attendee for this ticketHiddenFull Name HiddenAddress HiddenEmail HiddenProf Title HiddenEmployer/Organization Ticket E Quantity1 DAY Saturday Only Survivor Program Price: $50.00 Quantity HiddenTicket E: Attendee DetailsPlease enter the Name and Emails of each attendee for this ticketHiddenFull Name HiddenAddress HiddenEmail HiddenProf Title HiddenEmployer/Organization Ticket FS Quantity2 Day Friday Advocacy in Action Conference and Saturday Survivor Program Price: $150.00 Quantity HiddenTicket FS: Attendee DetailsPlease enter the Name and Emails of each attendee for this ticketHiddenFull Name HiddenAddress HiddenEmail HiddenProf Title HiddenEmployer/Organization Student Rates Student ID must be presented at registration Student Ticket 3 Day Quantity Price: $100.00 Quantity HiddenStudent Ticket 3 Day: Attendee DetailsPlease enter the Name and Emails of each attendee for this ticketStudent Ticket 2 Day Quantity Price: $75.00 Quantity HiddenStudent Ticket 2 Day: Attendee DetailsPlease enter the Name and Emails of each attendee for this ticketStudent Ticket 1 Day Quantityplease designate which day: Thursday, Friday, Saturday or School Summit Price: $35.00 Quantity HiddenStudent Ticket 1 Day: Attendee DetailsPlease enter the Name and Emails of each attendee for this ticketSchool Summit Tickets This as an Separate event on Thursday, not part of the main conference Ticket SS Quantity1 Day Thursday School Summit If you wish to return on Friday and/or Saturday, you can add the 1 Day Friday Conference and/or the 1 Day Saturday Survivor Program by selecting those tickets above in addition to the 1 Day Thursday School Summit ticket or you may select Ticket FS to add both Friday and Saturday Price: $100.00 Quantity HiddenTicket SS: Attendee DetailsPlease enter the Name and Emails of each attendee for this ticketHiddenFull Name HiddenAddress HiddenEmail HiddenProf Title HiddenEmployer/Organization or School/District Certified Training Sessions This year, Kevin’s Song will be offering certified training sessions for Safe Talk and QPR on Thursday afternoon after the end of the School Summit.Ticket STC QuantitySAFE TALK CERTIFICATION (limited to 30 trainees) Thursday, January 23, 2020 - 3:15pm – 5:15pm Price: $15.00 Quantity HiddenTicket STC: Attendee DetailsPlease enter the Name and Emails of each attendee for this ticketTicket QPR QuantityQPR CERTIFICATION (limited to 30 trainees) Thursday, January 23, 2020 - 3:15pm – 5:15pm Price: $15.00 Quantity HiddenTicket QPR: Attendee DetailsPlease enter the Name and Emails of each attendee for this ticketPayment Method* Paying By Check Using this order to create a PO Total $0.00 CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
