3rd Annual Conference (24 CEU’s possible including 6 in Ethics)

Oct 27th—Oct 30th, 2016 Mission Bay Hyatt — San Diego, CA

Registration is now open!!!!

P.O Box 214127

Sacramento, CA 95831

3rd Annual Conference REGISTRATION (Both Sides Must Be Completed)

(To qualify for Early Registration, payment and this form must be received by Oct 1st, 2016)

(On-site registration starts at 7:00 a.m. each day, presentations begin at 8:00 a.m., onsite registration fees will be 15% higher)

FULL REGISTRATION — MEMBER

$250.00

Starts Thursday, Oct 27-30th includes Badge, CCAPP

Conference Bag, Program, daily continental breakfast,

coffee breaks, VIP Halloween Dance Party, presenta-

tions, CEU’s & FUN!.

$________

FULL REGISTRATION — NON MEMBER $350.00

Starts Thursday, Oct 27-30th includes Badge, CCAPP

Conference Bag, Program, daily continental breakfast,

coffee breaks, VIP Halloween Dance Party, presenta-

tions, CEU’s & FUN!

$________

DAILY REGISTRATION

Member (per day) $150.00 Non-Member (per day) $250.00

Includes program , Badge, CCAPP Con-

ference Bag, continental breakfast.,

membership Lunch, VIP Reception, and

coffee breaks. (Lunch will be offered on

Saturday’s registration. VIP Halloween Dance Party & Costume

Contest. (Prizes for best Costume)

Full conference (Thursday—Sunday)

Thursday, October 27, 2016 (one day)

Friday, October 28, 2016 (one day)

Saturday, October 29, 2016 (one day)

Sunday, October 30, 2016 (one day)

$________

$________

$________

$________

$________

Raffle Tickets $1 each (All Raffles will be held in the

Exhibit Hall on breaks, and breakfast)

$________

CCAPP Stainless Steel Mug with Handle $10 each

(This mug can hold your hot coffee, hot cocoa, or tea)

$________

STUDENT

Full Registration $175.00

Daily $100.00 Proof of enrollment required, may not be certi-

fied/licensed. Full registration Includes Meals;

daily registration does not include meals.

Full conference (Thursday—Sunday)

Thursday, October 27, 2016 (one day)

Friday, October 28, 2016 (one day)

Saturday, October 29, 2016 (one day)

Sunday, October 30, 2016 (one day)

$________ $________

$________

$________

$________

Program/Member Discount: All program/agency members get 30% off

registration (one registration). Only full

conference attendees get this. Individual

member of CCAPP will be eligible to re-

ceive the individual membership discount

and not the program member discount

Sub-Total $________

Late Fee if submitted after Oct 1st, 2016 $25.00

I have been a CCAPP Member for

___________years.

GRAND TOTAL DUE – Transfer to Page 1 for Use With

Payment Instructions

$________

I am a CCAPP Board Member Speaker/Presenter

*Extra Meals: Membership Lunch on Saturday $45.00 ________ *Extra Meals: Lunch on Friday $45.00________

Do you have special “access” needs to attend presentations?______________________________________

Special Dietary Needs: Vegetarian Vegan Other:______________________________________

(Check this box ONLY if you are a full registrant attending the lunch)

Please FAX or MAIL completed form to: (916)-338-9468 or CCAPP P.O Box 214127 Sacramento, CA 95821.

California Consortium of Addiction Programs & Professionals

Instructions: 1. One registration form per attendee. PLEASE PRINT USING A PEN. Please keep a copy of this form for your records. 2. CCAPP Full members qualify for ‘Member Rates’. 3. Payment must accompany form or registration will not be processed. 4. Program discounts available to Program Members, deduct 30% for one registration. Visit our website for a list of agency members. 5. Checks should be made payable to CCAPP. Returned checks and declined credit cards are subject to a $35.00 charge. 6. Badges must be worn at all times. Entrance to food functions limited to those individuals with badges and arm bands/tickets.

Spouses and guests are required to register or purchase wrist bands for extra lunch. 7. Cancellations must be submitted in writing to CCAPP at the address below. Requests for cancellations received after Sept 14,

2016 are subject to 50% cancellation fee. No refunds will be made after Oct 1, 2016

*NSF Checks will result in an additional fee of $35.00, Declined credit cards will result in an additional $35.00 fee.

PAYMENT

After completing the reverse side of the registration form, please transfer Total Fees owed from Page 2 to Page 1 and indicate your method of payment. Again, payment MUST be received with Registration Form.

TOTAL FEES: $_______________ Method of Payment: Check #______________ Credit Card: □MasterCard □ Visa □ Am Ex □ Discover

Card #: ________________ - _________________ - __________________ - ____________________ Exp:________________

Signature: _____________________________________________________________________________________________________________

Name as it appears on card:________________________________________________________________________________________________

Name of Registrant:___________________________________________________________________________________________ (First) (Last) (MI) Certifications: ________________________________________________________________________________

Name for Badge if Different from above:_______________________________________

Mailing Address ______________________________________________________________________________________________________________ (Street) (City) (State) (Zip) Email Address:_________________________________________________________ Day Phone:_(________)____________________________ Fax:__(__________)______________________________ Employer (Optional): ________________________________________________________________________________________________________

California Consortium of Addiction Programs & Professionals

3rd Annual CCAPP Conference October 27, 2016—October 30, 2016

Hyatt Regency Hotel 1441 Quivira Rd. San Diego, CA 92109

619-224-1234 Room Rates start at $120.00 night

(Ask for the CCAPP Rates) *Last day to book hotel is TBA.

CCAPP Membership Number*: _______________________ *Membership Number can be found on CCAPP Membership card. RADT-1, Certification or Licensure are NOT the same as full membership. You can apply for membership on the ccapp.us website

Please FAX or MAIL completed form to: (916)-338-9468 or CCAPP P.O Box 214127 Sacramento, CA 95821.

SPEAKERS

Include

Dr. George F. Koob, Jerry Moe, Kenneth Minkoff M.D. and more!

California Consortium of Addiction Programs & Professionals

We welcome all addiction treatment counselors, social workers, therapists, physicians, nurses, and interventionists as well as the addiction treatment providers, behavioral healthcare organizations and mental health providers.

SPECIALTY WORKSHOP Some specialty topics we have available

are: Clinical Supervision

Cultural and Diversity Issues

LGBTQ

Families

Clinical Issues

Criminal Justice & DUI

Ethics and Professional Issues

Prevention

AOD Prevention

Pharmacotherapy

Personal and Professional Wellness

Private Practice

Managed Care

Intervention & Referral

Sober living

Women’s Treatment

Marketing & Administration

VENUE: San Diego Our venue is Wonderful! CCAPP’S 3rd Annual Conference is located at the beautiful

Mission Bay Hyatt in San Diego

WHAT TO LOOK FORWARD TO:

Fun and excitement 12 Step meetings Exhibit Hall with over 60 Exhibitors Raffles 24 CEU’s Meeting new friends Networking with Professionals Cutting edge Presentations Great room rates Future bosses Giveaways Updates with the AOD Profession Awesome conference Friendly Staff

*If you are interested in Exhibiting, Sponsoring, or Advertising at our event please contact Kristina Padilla at kristina@ccapp.us or at 1-916-338-9460 ext.112

THE PREMIER “Conference” FOR ADDICTION-FOCUSED PROFESSIONALS –24 CEU’s-