SPAN Idaho's 10th Annual Suicide Prevention Conference - Online Registration
Wednesday, September 8—Friday, September 10, 2010

Participant Information:

Name (First & Last)
Street Address
City
State
Zip Code
Phone Number
Alternate Phone Number
Email

Please Mark Your Selection For Each Session Time:

Thursday, September 9th, 10:15 a.m. (choose one)

Differing Perspectives on Suicide
Partnerships... for Advocacy
Suicide in Older Adults

Thursday, September 9th, 1:15 p.m. (choose one)

Rising to Our Hopes, or Sinking to Our Expectations, PART 1
Intervention in Schools Following a Completed Suicide
Suicide Assessment for Clinicians

Thursday, September 9th, 2:45 p.m. (choose one)

Rising to Our Hopes, or Sinking to Our Expectations, PART 2
Suicide and the Economy Panel Discussion
Ethical Considerations When Dealing with Suicidal Risks

Friday, September 10th, 9:30 a.m. (choose one)

Helping Suicidal Service Members and Veterans
Survivor Support Groups
Prevention and Postvention for Clergy

I require special accommodations. Please specify...

SPAN Idaho Membership (Optional)

As a member of SPAN Idaho you become a partner in saving lives. By working together, we can decrease the high suicide rate in Idaho. Members receive a reduced rate at our statewide conference. Members will also be updated electronically with state and national prevention news and research. So, please fill in your email address. Memberships are valid for one year, July 1 - June 30. (with some flexibility depending on the month in which you join). Join us in making a difference.

$50 Individual Membership
$75 Family Membership
$35 Full-time Student Membership
$35 Age 65+ Membership

For scholarship and exhibitor information, please contact SPAN Idaho at info@spanidaho.org or 208-860-1703.

Conference Fee (Choose One)

$100 General Attendance Fee (Th & F)
$80 SPAN Idaho Member Fee (Th & F)
$100 General Attendance & Pre-Conf. Fee (W, Th & F)
$80 SPAN Idaho Member & Pre-Conf. Fee (W, Th &F)
FREE — Pre-Conference ONLY (W only)

REGISTRATIONS MUST BE RECEIVED NO LATER THAN FRIDAY, AUGUST 20, 2010.

TOTAL DUE: (SPAN Idaho Membership + Conference Fee)
Please make note of this amount as it will not carry over to the following payment page.