Conference Registration Forms
5th Annual National Peer Specialist Conference
Aug. 22-24, 2011
Raleigh-Where
Southern Charm Meets Peer Support!
Raleigh Sheraton Downtown
421 South Salisbury
Street, Raleigh, North Carolina 27601
Phone: (919) 834-9900 Fax:
(919) 833-1217
Note: This
is not the Airport Sheraton. The downtown Sheraton is approximately 30 minutes from the airport.
Transportation can
be arranged through Super Shuttle at 1-800-258-3826 24 hours in advance of arrival.
To register, please complete this form including payment information.
Each attendee must complete a separate form. The conference registration fee covers conference workshops, plenary sessions,
refreshment breaks and breakfasts. A pre-conference event is listed separately and there is NO fee for attending that event.
Please note: The National Association of Peer Specialists is NOT responsible for lodging, transportation, meals not included
with the conference or other costs. Participants are responsible for making their own arrangements including those costs.
Name ___________________________________________________________
Telephone
# ______________________________________________________
Street Address or P.O. Box __________________________________________
City
____________________________________________________________
State ___________________________________________________________
Zip_____________________________________________________________
E-Mail
Address (if available) ________________________________________
Special Needs (please indicate)______________________________________
Please
circle applicable selections and enter the total registration amount.
Note: If you are
not already a member, you may join the National Association of Peer Specialists (NAPS) now and receive the conference registration
discounts.
Full Conference
(2
½ days)
Early Bird
Before July 15, 2011 | Full Conference
(2 ½ days)
Regular Price
After July 15, 2011 | One Day attendance | Annual NAPS Membership
(Become a
member
now and enjoy the discount!) | Total Registration
(Fill in the total below) |
$195
member | $250
member | $150
member | $25
membership dues | Member
total: |
$230-non-
member | $290-non-member | $175 non-
member | | Non-Member total: |
NAPS is a non-profit
organization, Federal I.D. # 30-0293174, and is registered with the CCR for federal agencies.
Payment must accompany registration.
Checks should be made payable to “NAPS”
and sent with the registration form to:
NAPS, 755 Alta Dale, Ada, MI 49301.
To pay by
credit card, please provide the following:
Name on Card_________________________________
Phone #________________
Card #____________________________________
Expiration Date _______________________
Pre-Conference Institute
___ Yes! I wish to attend the pre-conference
institute (9 a.m. to Noon on Monday, Aug. 22) on Sustainability for Mental Health Organizations sponsored by OptumHealth Public
Sector.
(Please check box if you plan on attending).
There is NO cost
for this institute!
Exhibitor
Registration
5th Annual National Peer Specialist Conference
A limited
amount of exhibit space will be available for the National Association of Peer Specialists’ conference in Raleigh, NC,
August 22-24, 2011. Organizations and micro-enterprises involved in mental health are invited to participate. The exhibit
hours will be 9 a.m. to 6 p.m. on Monday and Tuesday (Aug. 22-23) and 9 a.m. to 1 p.m. on Wednesday (Aug. 24).
The
cost is $50 per table (6 feet long), which does not include electricity, Internet or phone services (these services may be
arranged separately with the hotel).
Exhibitors should note that the hotel charges a per box handling fee for
packages sent directly to the hotel.
Payment can be made by credit card or room charge.
To register
for an exhibit table(s), please complete the following:
Exhibitor Name(s) _____________________________________________
Exhibitor Company
____________________________________________
Street Address _______________________________________________
City
_________________________________________________________
State _______________________________________________________
Zip
_________________________________________________________
Phone# _____________________________________________________
I
am requesting _________ table(s) at $50 each.
Total: $________________
Send the completed form with
payment (check should be made out to “NAPS”) to:
NAPS, 755 Alta Dale, Ada, MI 49301
Note: Exhibitor registration fee does NOT include conference registration fees, meals or refreshment breaks. NAPS
is not responsible for lost or stolen items.
