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Registration for: 2019 Suicide Prevention Conference

Wednesday, October 2, 2019

First Name
Last Name
Credentials
Title
Organization
Address
City
State
Zip
Phone
Email (required for email confirmation)
NOTE: You will receive an email confirmation from webserver@moderntymes.com. You may want to add this address to your spam filtering "safe senders" list or whitelist to make sure you receive the message.
Payment type Pay $95 conference fee by:
Credit Card
Check
Purchase Order
Agency Transfer (Reference code BHSB-TC 05)
Please Note: After September 26th registrations will not be refunded. Registrants who are no-shows will not receive a refund.
Student Rate?
Check to receive discounted student rate of $55.00
(check one of the above payment options)
Limited space available; must bring current student ID.

Workshops Session 1
(choose one)

see workshop details
1. Save a Shore Farmer – A Campaign of Outreach to Farmers & Farm Families
2. Assessing Mental Health Needs in the Black Church
3. Perceptions of Familial Support Around Suicidal Crises
4. Online Interactions and Suicide: It's More than Social Media
5. Loneliness and Social Isolation: Risk Factors for Suicide
6. Unifying Immigrant Families for Youth Suicide Prevention
Workshops Session 2
(choose one)

see workshop details
1. Urban Voices: Guidance on Treatment of Urban Native Americans
2. How the Church Can Partner with the Community
3. Human Sex Trafficking: Behavioral Health Issues and Treatment Recommendations
4. Engaging Peers in Suicide Prevention Training: A Peer Ambassador Approach in High Schools
5. Different Cultural Perspectives Around Suicide and Its Prevention
Workshops Session 3
(choose one)

see workshop details
1. Responding to Mental Health Issues in Older Adults
2. Postvention as Prevention: Supporting Suicide Loss Survivors
3. Maryland’s Extreme Risk Protective Order Law: A New Tool for Preventing Suicide
4. Partnership Between Crisis Centers & First Responders
5. Trauma in the Lives of Gang Involved Youth
6. More Than Sad
Attendance verification Continuing Education Units (CEU)
For social workers, psychologists, professional counselors, therapists, and alcohol and drug counselors
Certificate of Attendance (COA)
For nurses and all other disciplines

PO Number

(purchase orders only)

Hearing interpreter
(Check if required)
Please call 410-646-7758 for interpreter

Special Accommodations
(Check if required)
NOTE: This does not include food.
Please describe any special accommodations required.