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2016 Spring Workshop Registration

Mental Health for Minor-Attracted People: Keeping Wellness First - April 22, 2016
Thank you for your interest in attending our spring 2016 workshop. Registration is open to mental health practitioners, researchers, educators, and students. If you are a mental health or criminal justice advocate, a member of the media, an MAP, or a friend or family member of an MAP, you may also use this form to apply for an invitation to attend.


Note for MAPs, friends, and family members: To protect your privacy, you may use a pseudonym and pseudo-mailing address. You will be contacted by email for more information.

If you have any questions, please email rkramer@b4uact.org.
* Required
First Name *
Your answer
Last Name *
Your answer
Institution
Required unless MAP, friend, or family member
Your answer
Position
Required unless MAP, friend, or family member
Your answer
Address *
Your answer
City *
Your answer
State or Province *
Your answer
Zip/Postal Code *
Your answer
Email Address *
Unless attending as an MAP or friend or family member, we require your official email address supplied by your institution, not your personal email address.
Your answer
I am a: *
Payment method *
Submit
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