CASAT - Prevention, Intervention, Treatment, Recovery
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Saying It Out Loud Conference (Wednesday, May 22, 2013)

Contact Information

First Name:
(This name will appear on your name badge and certificate.)
Middle Name / Initial:
Last Name:
(This name will appear on your name badge and certificate.)
Title:
Agency/Organization:
Mailing Address:
City:
State:
Zip Code:
Area Code and Phone Number:
Area Code and Fax Number:
Participant Email Address:
(will receive confirmation)
Confirm Participant Email:
Send Copy of Confirmation
To This Email Address:

(in addition to participant confirmation email)
Special Accommodations: Please specify any special needs. (i.e. accessibility for people with disabilities, other needs).


Participant Registration Information

Primary Employment Type(s): Check ALL that are applicable. If your primary employment type is not listed, add it in the 'Other' field.

Aging and Adult Services
Chemical Dependency
Child Welfare
Corrections
Developmental Disabilities
Education
Mental Health
Student
Veterans
Unknown

 Other:
Employer(s): Check ALL that are applicable. If your employer is not listed, add it in the 'Other' field.

Center for Human Services
King County Mental Health Chemical Abuse and Dependency Services Division
Seattle Counseling Services
Sound Mental Health
DSHS - Aging and Long-term Support Administration
DSHS - Behavioral Health and Service Integration Administration
DSHS - Childrens Administration
DSHS - Developmental Disabiliites Services Administration
DSHS - Economic Services Administration
DSHS - Juvenile Justice and Rehabilitation Administration
DSHS - Secretarys Office

 Other:
SIOL Conferences Attended:
Lunch Choice: Not Vegetarian Vegetarian


Cancellation Policy

We expect that there will be great demand to attend this conference. If you are unable to attend the conference, please contact CASAT no later than Wednesday, May 08, 2013 (contact information below), so your reservation may be opened up for others to attend. Thank you.

If you have any questions or need assistance with registration, please contact CASAT (dbhr.support@casat.org) or call 775.784.6265 or toll free 877.922.6635.
Please check that you have read and understand the cancellation policy.


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