2017 marrch annual conference - cdn.ymaws.com · 2. the song remains the same rick moldenhauer, mn...
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Driving Excellence in Addiction Care
Minnesota Association of Resources for Recovery and Chemical Health
1000 Westgate Drive, Suite 252 | St. Paul, MN 55114
P: 651-290-7462 | E: [email protected] | w: www.marrch.org
2017 MARRCH ANNUAL CONFERENCE
St. Paul RiverCentre, St. Paul, MN | October 30–November 1, 2017
REGISTRATION BROCHURE
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Join us at the 48th Annual MARRCH ConferenceThe MARRCH Board of Governors invites you to the 48th Annual
MARRCH conference.
The Education Committee has provided us with a great learning
opportunity. With all the changes in our profession, we must
make a commitment to consistently take advantage of learning
experiences; it is our responsibility to ourselves and to our
clients. Learn at the conference; network with your colleagues;
be part of our celebrations; visit with MARRCH staff and the
board of governors; consider taking an active part in the
message and mission of MARRCH — being the voice of addiction
treatment professionals. Without your voice, we will not be as
easy to hear! We look forward to seeing you at the conference
and saying hello!
- MARRCH Board of Governors
Thank you, Conference Planning Committee!
• Chair: Jenine Koziolek, Fountain Centers
• Dustin Chapman, Behavioral Services @ U of M Medical Center
• Melanie Heu
• Jonathan Lofgren, Minneapolis Community and Technical College
• Charlie Mishek, DHS
• Annette Pearson
• Jose Picon, Huss Center for Recovery
• Dianne Seger, MN Department of Corrections
• Saul Selby, MN Adult Teen Challenge
• Kevin Spading, Metropolitan State University
• Pamela Wood, Hazelden Betty Ford Graduate School of Addiction Studies
• Jake Zimmerman, Anthony Louis Center
1) Screening means the process by which a client is determined appropriate and eligible for admission to a particular program.
2) Intake means the administrative and initial assessment procedures for admission to a program.
3) Orientation means describing to the client the general nature and goals of the program; rules governing client conduct and infractions that can lead to disciplinary action or discharge from the program; in a nonresidential program, the hours during which services are available; treatment costs to be borne by the client, if any; and client rights.
4) Assessment means those procedures by which a counselor identifies and evaluates an individual’s strengths, weaknesses, problems, and needs for the development of the treatment plan.
5) Treatment Planning means the process by which the counselor and the client identify and rank problems needing resolution; establish agreed-upon immediate and long-term goals; and decide on a treatment process and the sources to be utilized.
6) Counseling means the utilization of special skills to assist individuals, families, or groups in achieving objectives through exploration of a problem and its ramifications; examination of attitudes and feelings; consideration of alternative solutions; and decision making.
7) Case Management means activities that bring services, agencies, resources, or people together within a planned framework of action toward the achievement of established goals.
8) Crisis Intervention means those services that respond to an alcohol or other drug user’s needs during acute emotional or physical distress.
9) Client Education means the provision of information to clients who are receiving or seeking counseling concerning alcohol and other drug abuse and the available services and resources.
10) Referral means identifying the needs of the client that cannot be met by the counselor or agency and assisting the client to utilize support systems and available community resources.
11) Reports and Record Keeping means charting the results of the assessment and treatment plan, writing reports, progress notes, discharge summaries and other client-related data.
12) Consulting with other Professionals regarding client treatment and services means communicating with other professionals in regard to client treatment and services to assure comprehensive, quality care for the client.
13) Cultural: Men, Women, Adolescent/Child, LGBTQ, African-American, American Indian, Asian, Hispanic, Mental Health, Elderly
Core Functions
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48th Annual MARRCH Conference Sessions
* Ethics courses are highlighted with an asterisk.
MONDAY, OCTOBER 308 – 9 AM
KEYNOTE Lynn Madden, APT Foundation
9:30 – 11:30 AM
1. Safety in Self-Help Groups* John Donovan, MN National Guard
Core Function: ReferralEthics 2. The Song Remains the SameRick Moldenhauer, MN DHS, ADAD
Core Function: Assessment
3. New Tools for a New Millennium: Using Research and Technology to Improve Recovery Support Services to Improve Recovery Outcomes Janelle Wesloh, Hazelden Betty Ford Foundation
Core Function: Case Management 4. Recovery from Opioid Use and Addiction Utilizing Medication-Assisted Treatment with MethadoneLeighann Straughen, New Season-Colonial Management Group, LP
Core Function: Counseling 5. Beyond the Triad — Looking at Person-Centered Treatment PlanningSteve Lansing, Empower CTC; Ann Lansing, Empower CTC
Core Function: Treatment PlanningCultural: Mental Health
6. Addressing Diet Culture in Substance Use TreatmentMichelle Wilson, MN DHS
Core Function: Consulting with other ProfessionalsCultural
7. Gambling Treatment Beyond the 12 Steps Craig Johnson, Club Recovery
Core Function: Counseling, Treatment Planning
1 – 3 PM
8. Navigating CFR 42 Part 2: Confidentiality of Substance Use Disorder Patient RecordsEric Bjerva, Arctos Law; Mitchell Faas, Arctos Law
Core Function: Reports and Record Keeping
9. Byte the Bullet: Overcoming Resistance to Telehealth and Technology in Behavioral Health CareRoxanne Kibben, R. Kibben Company
Core Function: Assessment, Case Management, Treatment Planning
10. Recognizing and Relying on African American Cultural Strengths in Behavioral Health TreatmentJonathan Lofgren, Minneapolis Community and Technical Colege
Core Function: Counseling
11. Brief Behavioral Assessments: Enhancing Assessment and Treatment, and Measuring OutcomesJonathan Hoistad, Natalis Outcomes; Richard Sethre, Natalis Outcomes
Core Function: Assessment, Reports and Record Keeping, Treatment Planning
12. Merging Narrative Therapy with Brain Science to Re-write and Re-wire the Effects of TraumaJohn Stillman, Caspersen Therapy and Training Center
Core Function: Crisis Intervention, Treatment Planning
13. Overcoming Obstacles to Recovery: The Role of Occupational Therapy in Co-Occurring Substance Abuse and Eating DisordersSamantha Thayer, Melrose Center; Kisha Patterson, Melrose Center
Core Function: Consulting with other ProfessionalsCultural
14. Coming Out of Hiding: Minnesota’s Experience in Providing Peer Support for Nurses with SUDMarie Manthey, Minnesota Nurses Peer Support Network; Dawn King, Minnesota Nurses Peer Support Network; Deborah Matthais-Anderson, Metropolitan State University
Core Function: Counseling, Reports and Record Keeping
3:15 – 5:15 PM 15. Effective Co-Occurring Disorders Treatment with 18-25 Year OldsFred Dyer, Hope Recovery Center
Cultural
16. Drug Testing Interpretation in Addiction CareBrandi Puet, Aegis Sciences Corporation
Core Function: Assessment
17. Dosage Probation Initiative in Washington CountySheri Vrieze, Canvas Health; Terry Thomas, Washington County Community Corrections
Core Function: Treatment Planning 18. Barriers to Cost-Effective, Evidence-Based SUD Treatment: Findings from a Recent MMB Benefit-Cost AnalysisWeston Merrick, Minnesota Management & Budget
Core Function: Counseling, Treatment Planning
19. Client Training for Physiological Change with Objective Assessment and Outcome MeasuresJohn Anderson, Minnesota Neuro-Training Institute
Core Function: Assessment, Consulting with other Professionals, Treatment Planning
20. Addiction and Family Dynamics: Working with Families to Invoke ChangeTanya Friese, Project Turnabout; Lyndsie Murphy, Project Turnabout
Core Function: Counseling
21. Whole Person Care: A Platform We Can All Get BehindJinny Phalen, Minnesota Association of Community Mental Health Programs
Core Function: Assessment, Intake, Referral
TUESDAY, OCTOBER 319 – 11 AM
22. The Ethics of Treating Opioid Use Disorders*Jordan Hansen, Hazelden Betty FordEthics 23. Syphilis on the Rise in MN: Who Should Be Concerned and WhyCandy Hadsall, MDH
Core Function: Client Education
24. Neurospirituality: The Science of How Spiritual Practices Transform the Brain and BodyTim Walsh, Minnesota Adult and Teen Challenge
Core Function: Counseling
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48th Annual MARRCH Conference Sessions
* Ethics courses are highlighted with an asterisk.
25. Minneapolis VA’s Intensive Outpatient Program: Screening, Treating, and Tracking Veterans Stephanie Bertucci, Veterans Health Administration; Marcus Moore, Veterans Health Administration; Daniel Silversmith, Minneapolis VA; Megan Welu
Core Function: Case Management, Counseling, Screening, Treatment Planning
26. Counseling as Storytelling Rik Lundgren
Core Function: Client Education, Counseling
27. What it Looks Like Here: Gambling in the Lao CommunitySunny Chanthanouvong, MN DHS; Helen Ghebre, MN DHS
Cultural
28. Intertribal Means Everyone Is Invited. So Don’t Sit this One Out.Molly Murphy, Mash-ka-wisen Treatment Center; Steve Thomas, Mash-ka-wisen Treatment Center
Core Function: CounselingCultural: Native American
11 AM – 12 PM
KEYNOTE: Smoke and Mirrors: The Straight Dope on Legalized Cannabis & the Healthcare ProfessionalChris Bundy, Washington Physicians Health Program 1 – 3 PM
29. Designing DiversityTim Gregory, Progress Valley III
Cultural: Men
30. Mechanisms of AddictionCharles Schutt, Progress Valley
Core Function: Client Education
31. Improving Access and Retention: Using New Technology, ASAM, and Evidence-Based Practices with Your ClientsCharlie Mishek, MN DHS, ADAD
Core Function: Case Management, Counseling, Referral, Treatment Planning
32. Gambling, SUD, & Co-Occurring DisordersSheryl Anderson, Project Turnabout
Core Function: Consulting with other Professionals
33. Family-Centered CareJessie Everts, Wayside Recovery Center
Core Function: Counseling, Treatment Planning
34. Peer Support and Peer SupervisionKris Kelly, Minnesota Recovery Connection
Core Function: Consulting with other Professionals
35. What You Need to Know about DAANES and CHATSBrian Zirbes, MN DHS, ADAD; Carl Haerle, MN DHS, ADAD
Core Function: Case Management, Reports and Record-Keeping
3:15 – 5:15 PM
36. The Intersection of Chemical Health & HIVMegan Mueller, MN AIDS Project; Christy Rushfeldt, MN AIDS Project
Core Function: Assessment, Client Education
37. Parenting the Addicted Teen and Young Adult After Treatment — Five Key Strategies to Help Parents Thrive!Barbara Krovitz-Neren, Competent Parents, Competent Kids
Core Function: CounselingCultural: Adolescent
38. Can We Talk? Exploring the Disease Model With an Open MindBarry Lehman, Mayo Clinic Addiction Services
Core Function: Treatment Planning
39. Finding Balance within an Ever-Changing Self: Counselor Self-Care for the Prevention of Compassion Fatigue, Burnout, and Vicarious Trauma* Rashida Fisher, Adler Graduate School; Kristin Williams, Adler Graduate School
Core Function: Client Treatment, Consulting with other ProfessionalsEthics
40. The Warrior Counselor: Building Resilience Against Compassion Fatigue and BurnoutMatthew Lindberg; Jeremiah Schimp
Core Function: Counseling
41. Slick Speaks on Ethics*Saul Selby, Minnesota Adult and Teen Challenge; Ben Stapp, Minnesota Adult and Teen Challenge
Core Function: Client EducationEthics
42. Coming Home to the Self: Overcoming ShameTamarah Gehlen, House of Charity/Adler Graduate School
Core Function: Counseling, Treatment Planning
WEDNESDAY, NOVEMBER 18 – 10 AM
43. Making a Case for Clinical Supervision: Ethics & Outcomes*Amanda Richards, Metropolitan State University and Amanda Richards Consulting; Cindy Meyer, Northern Cities Therapy; Sally Guiller, BBHT
Ethics
44. Increase Your Client’s Recovery SuccessEllie Peterson, Power of Positive Workouts
Core Function: Client Education, Treatment Planning
45. Finding Effective Methods of Enhancing Motivation for ChangeLarry Silverness, Amethyst Consulting Services, Inc.
Core Function: Counseling, Client Education 46. Social Skills Training for Substance Use DisordersTanya Line, University of Minnesota - MNCAMH
Core Function: Treatment Planning
47. Overdose Prevention and Naloxone TrainingRandy Anderson, Steve Rummler Hope Foundation; Lexi Reed-Holtum, Steve Rummler Hope Foundation
Core Function: Crisis Intervention
48. Creating A Great, Evidence-Based LectureSaul Selby, Minnesota Adult and Teen Challenge; Ben Stapp, Minnesota Adult and Teen Challenge
Core Function: Client Education
10:30 – 11:30 AM
KEYNOTE: Matters Of Gender: Masculinity, Treatment, & Recovery Mic Hunter, LMFT
12:30 – 2:30 PM
49. Ethical Best Practices: How to Do the Right Thing and Make a Difference at the Same Time*MARRCH Ethics CommitteeEthics
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50. Practicum to ProfessionalKenneth Roberts, NuWay House; Tiffany Dockham, NuWay House
Core Function: Counseling
51. Professional Identity and Integrated CareTherissa Libby, Metropolitan State University; Debra Wamsley, University of Minnesota
Core Function: Consulting with other Professionals, Counseling
52. Developing and Implementing CBT Strategies for Co-Occurring Disordered ClientsHal Baumchen, Northland Counseling Services
Core Function: Counseling
53. Thingification: The Impact of Porn on People, Relationships and SocietyTamarah Gehlen, House of Charity/Adler Graduate School
Core Function: CounselingCultural
54. Substance Use Disorder Reform for Minnesota and the FutureBrian Zirbes, MN DHS, ADAD
62. Understanding East African Clients, Somali 101Yussuf Shafie, Alliance Wellness Center
Core Function: Reports and Record-KeepingCultural
3 – 5 PM
55. Problem Gambling and Drug Addiction as Co-Occurring DisordersJohn VonEschen, Northstar Problem Gambling Alliance; Mary Dahnert, Resilience Counseling
56. Wired for Digital Addiction: Treating Your Tech-Addicted ClientsMathew Meyers, Traverse Counseling & Consulting; Mike Kosim, Traverse Counseling & Consulting
Core Function: Assessment, Treatment Planning
57. CCBHC: Lessons Learned from the First ImplementersHeather Geerts, Zumbro Valley Health Center
Core Function: Consulting with other Professionals
58. Best Practices for Handling Demands for Patient Information in the Face of Changing Federal Substance Use Disorder Privacy LawsGerald Fornwald, Winthrop & Weinstine
Core Function: Reports and Record Keeping, Screening
59. Opioids: Pharmaceutical, Heroin and Fentanyl. Brain Disease and MAT Ed Baker, Aspenti Health
Core Function: Counseling, Crisis Intervention
60. Substance Use Disorder Reform for Minnesota and the FutureBrian Zirbes, MN DHS, ADAD
61. Supervising the Millennial Counselor: Tips and TechniquesJennifer Londgren, Minnesota State University, Mankato
General InformationLodging: Room discounts are available at the Holiday Inn across from the Xcel Center. The rate is $134 per night for single/double rooms, plus tax. For reservations at the Holiday Inn, call 651-225-1515. Be sure to ask for the MARRCH 2017 Conference rates when calling. The conference rate cutoff date is Wednesday, November 1, 2017.
Parking: Parking is available at the RiverCentre ramp, or the Holiday Inn. Please note: The RiverCentre ramp has early-bird rates.
Fees: Registration fees include CE certificates and food service. Shared full conference registrations are not permitted. To receive the early bird discount, your registration must be received on or before October 2, 2017.
Exhibits: Three full days of exhibits! For information and/or an application, call the MARRCH office at 651-290-7462 or register online.
Continuing Education Hours: 21 CEs available, 7 are available each day of the conference.
Approval for credits is pending from the Board of Behavioral Health and Therapy for LADC, LPC and LPCC Continuing Education Credit. Approval for continuing education credits is also pending with the Minnesota Board of Psychology, the Minnesota Board of Social Work, the Minnesota Board of Marriage and Family Therapy, and the Upper Midwest Indian Council on Addictive Disorders. The Minnesota Board of Nursing does not approve CE activities; however, nurses may apply for credits on an individual basis if the workshop criteria meet the board’s guidelines. Continuing education clock hours will be endorsed by MARRCH and certificates of attendance are provided online 30 business days after the conference.
CE Tracking and Certificates: MARRCH is now tracking your CE credits for you.
INSTRUCTIONS:1. Visit www.marrch.org2. Login to access your member profile.3. Click on the Professional
Development button.
*CE Certificates for the 2017 Annual Conference will be available 30 business days after the conference ends and full payment for the conference must be received before attendees will be able to access certificates.
If you have any questions, please call the MARRCH office at 651-290-7462.
Payment Policy: Please do not email forms with credit card information. To protect your data and to comply with PCI standards, the MARRCH office will not accept emailed credit card information. To be considered preregistered, full payment must accompany your registration form. For all other registrations, including on-site registrations, payment must be made at the time of registration. We do not allow invoicing for onsite registration. Payment by cash, check or charge only.
Cancellation Policy: With online cancellation notice received by October 6, 2017, you will receive a full refund, less a $50 administrative charge. Cancellations after Oct. 6 are nonrefundable. Notices of cancellation must be submitted online to the MARRCH office at marrch.org/cancellation. No-shows will not receive refunds.
6 Current as of August 28, 2017
Thank You, MARRCH Conference Sponsors
Thank You, MARRCH Conference Exhibitors
Aegis Sciences Corporation Argosy University Aspenti HealthAugsburg University Stepup Program Beauterre Recovery InstituteBegin Healing, Inc.Drew Horowitz & Associates, LLCElite RecoveryHazelden Betty Ford Foundation Melrose Center
Meridian Behavioral Health MHS (Mental Health Systems)Minnesota Association of Community
Mental Health Programs (MACMHP) Minnesota Certification Board (MCB) Minnesota Department of
Corrections New Beginnings MN Northstar Behavioral Health Options Family & Behavior Services
People Incorporated Recovering Hope Treatment Center River Ridge Riverplace Counseling Center RS Eden The Gables The Heights The Pride Institute The RetreatTraverse Counseling & Consulting
Adler Graduate School Adolescent Treatment Center of
Winnebago Alcohol and Drug Abuse
Division - Minnesota Department of Human Services
Allina HealthAnthony Lewis CenterArbor Place, Inc.Assurance LaboratoriesAVIVO Behavioral Healthcare Providers Burkwood Treatment Center Club Recovery, LLC Cochran Recovery Services, Inc.C.R.E.A.T.E., Inc. Crossroads Aftercare Program Edens Group, Inc Fairview Recovery Services Faith Family Recovery Center
Fountain Centers Freedom Center Genoa Haven Chemical Health Systems House of Charity House of Hope, Inc. International Institute for
Trauma and Addiction Professionals (IITAP)
Journey Home - Recovery Plus Journey to RecoveryKeystone Treatment CenterKinnic Falls ADA Services Lakeplace Retreat Center Living Free Recovery Services Livio Health Group Mash-Ka-Wisen Treatment
Center Metropolitan State UniversityMicah Houses Millennium Health
Minnesota Adult & Teen Challenge
Minnesota AIDS Project Minnesota Association of Sober
Homes Minnesota Organization on
Fetal Alcohol Syndrome (MOFAS)
New Season Northstar Problem Gambling
Alliance Nurses Peer Support NetworkNuway House, Inc Nystrom & Associates, Ltd. Park Avenue Center P.E.A.S.E. Academy PrairieCare Premier Biotech Labs, LLC Procentive Progress Valley, Inc. Project Turnabout
Recovery Plus - St. Cloud Hospital
Restoration Counseling & Community Services
Rogers Behavioral Health - Minneapolis
ShareHouse The Duluth Bethel The Helpers Transformation House, Inc. University of Minnesota
- College of Continuing Education
Valley Pain Relief and Wellness Center
Vinland Center Wayside House, Inc. Wellcome Manor Family
Services West Hills Lodge Wings
EXHIBIT BOOTHS
PREMIER EXHIBIT BOOTHS
Lunch SponsorLivio Health Group
Conference Bag Sponsor
Minnesota Adult and Teen Challenge
Conference Lanyard SponsorNew Season
Breakfast SponsorsMHS (Mental Health Systems)
NuWay House, Inc.
Coffee Break SponsorsDrew Horowitz & Associates
Elite RecoveryVinland Center
Awards Ceremony SponsorThe Duluth Bethel
MARRCH Counselor of the Year Award Nomination
About the AwardThis award is given annually at the MARRCH Fall Conference to recognize no more than two licensed alcohol and drug counselors (LADC) who work directly with clients in the addiction field. You can also fill out a nomination at www.marrch.org. The recipient(s) will be chosen by the MARRCH Board of Governors.
• Please note the spirit, skills and qualities of the candidate’s work that make this individual an outstanding addiction counselor.
• Please describe an instance where you actually witnessed this person doing something to assist a person that was over and above the
general duties of the job.
• Describe how this candidate strives to impact the addiction treatment field.
Eligibility• Must be a licensed alcohol and drug
counselor• Must be a member in good standing of
MARRCH• Nominee must currently provide direct
service to clients in the substance use disorder field
• Nominee must spend greater than 50% of his/her time working directly with clients, families or at-risk groups on addiction issues
• Must have worked in the field of addiction for at least five years
If the nominee is selected, you as the person submitting the
nomination, or a representative of your organization, will be asked to
present the award to the nominee at the annual conference.
Please complete and submit this nomination form so that it is
received by September 15, 2017.
Submit this form online (www.marrch.org) or send
nomination forms to the MARRCH Office at
1000 Westgate Drive Suite 252, St. Paul, MN 55114.
You may also fax this form to the office at 651-290-2266, or send it via
email to Bryan Mowry at [email protected].
Recipient will receive• Cash award ($300)• Proclamation from the Governor• Recognition plaque• Free registration for the next MARRCH
Spring Conference• Picture/name on sign
Counselor of the Year Nomination FormNominee’s name: _________________________________________________________________________________________________________
Nominee’s title: ___________________________________________________________________________________________________________
Nominee’s program/workplace affiliation: _____________________________________________________________________________________
Nominee’s address: ________________________________________________________________________________________________________
Nominee’s phone number__________________________________________ Email _______________________________________________________________
Description of what nominee’s job entails: _____________________________________________________________________________________
Nominee’s Licensed Alcohol and Drug Counselor number: ________________________________________________________________________
Number of years nominee has been in the field of addictions treatment: _________
Name of person completing this form: ________________________________________________________________________________________
Email of person completing this form: ________________________________________________________________________________________
Phone number of person completing this form:_________________________ Relationship to nominee: __________________________________
Using a page or less:
Submission Information:
Please send to: MARRCH1000 Westgate Drive Suite 252St. Paul, MN 55114Fax 651-290-2266
Register before October 2 for the best rate. No refunds after October 6. To register multiple attendees, please use this pdf registration form. All MARRCH mailings will be sent to the address you provide below, including a confirmation letter and name tag. Bring them to the conference for admission.Name _________________________________________________________________________________________________________________________________Agency ________________________________________________________________________________________________________________________________Work Address ___________________________________________________________________________________________________________________________City ______________________________________________________________________________State ______ Zip _______________________________________Work Phone___________________________________________________________Fax ______________________________________________________________Email (for confirmation)* _________________________________________________________________________________________________________________Are you a first-time attendee? mYes m No*You will get emails from [email protected]. Please make sure we are on your safe sender list.
Full conference registration includes all Monday, Tuesday, and Wednesday activities, and three days of exhibit hall access. For payment policy, see page 5.
Conference Registration (postmarked on or before Oct. 2) Full conference 1 day only Member** m $360 m $163 Nonmember m $435 m $205 Student/Temporary Permit*** m $205 m $96 If you chose 1 day only, select the date you will attend: m Oct. 30 m Oct. 31 m Nov. 1
Registration fee (from above) ........................................................................................................................................................................................................$ _____________If pre-registering after Oct. 2, add $25 .........................................................................................................................................................................................$ _____________If registering on-site, add $50 (This amount includes the $25 pre-registration amount from the line above) .............................................................$ _____________**You’re considered a member if you are an individual member or if you work for a MARRCH Agency Member
***The student rate is intended to enable students to attend who wouldn’t otherwise be able. To be eligible for the student rate, you need to be a current student at least part-time and cannot be working more than half-time.
MARRCH membership (membership effective for 12 months from time of payment) m Individual $75.......................................................................$ _____________ m Student/Retiree $30 ............................................................$ _____________ m Please send me membership info TOTAL DUE ..................................................................................$ _____________
St. Paul RiverCentre | 175 Kellogg Blvd. | Saint Paul, MN 55102
Monday, October 309:30 to 11:30 a.m.m1 m2 m3 m 4 m5 m6 m7 1 to 3 p.m.m8 m9 m10 m11 m12 m13 m143:15 to 5:15 p.m.m15 m16 m17 m18 m19 m20 m21
Tuesday, October 319 to 11 a.m. m22 m23 m24 m25 m26 m27 m28 1 to 3 p.m. m29 m30 m31 m32 m33 m34 m35 3:15 to 5:15 p.m. m36 m37 m38 m39 m40 m41 m42
Wednesday, November 18 to 10 a.m. m43 m44 m45 m46 m47 m48 12:30 to 2:30 p.m.m49 m50 m51 m52 m53 m54 m623 to 5 p.m. m55 m56 m57 m58 m59 m60 m61
fin.
(For office use only)
initialsdate
CK/CCamt. paid
bal. due
MARRCH 2017 Annual Conference RegistrationOctober 30–November 1, 2017
Cancellation Policy: With online cancellation notice received by October 6, 2017, you will receive a full refund, less a $50 administrative charge. Cancellations after Oct. 6 are nonrefundable. Notices of cancellation must be submitted online to the MARRCH office at marrch.org/cancellation. No-shows will not receive refunds.
Course Selections Indicate which sessions you will attend by checking only one box per time period:
IMPORTANT:In order to be registered, full payment must accompany the registration form. You will NOT be allowed to attend the conference without pre-payment. Invoicing will not be offered as an option at the conference.
Please do not email forms with credit card information. To protect your data and to comply with PCI standards, the MARRCH office will not accept emailed credit card information. To be considered preregistered, full payment must accompany your registration form. For all other registrations, including on-site registrations, payment must be made at the time of registration. We do not allow invoicing for onsite registration. Payment by cash, check or charge only.
Please note: Your completion of registration indicates your permission to be recorded (audio and/or visual).
m Check (made payable to MARRCH)m P.O. Number (must also attach your purchase order paperwork)___________________________________________________________________________________________m VISA m MasterCard If paying by credit, all credit card fields are requiredCard Number_____________________________________________________Exp. date ____________3-digit security code (req.) ___________________________Cardholder Name (print)_______________________________________________________________________Cardholder Phone ___________________________Cardholder Signature ____________________________________________________________________________________________________________________Credit Card Billing Address: m Same as address aboveAddress ________________________________________________________________________________________________________________________________City ______________________________________________________________________________State ______ Zip _______________________________________
Payment
Driving Excellence in Addiction Care