Virginia Summer Institute for Addiction Studies 2016

Registration Form

Last Name: First Name: ______

Institution/Agency:______

Phone (H): ______Phone (W): ______

E-Mail Address: ______

Do you wish to have your email address given to a vendor: YES NO

E-Mail address if different from above for vendor:______

Affiliation: VADAP VAAP SAARA VCB EVMS DJJ/DOC VCA NASW/VSCSW (Check all that apply)

Credentials:______

Required for CEUs through Old Dominion University:

Last 4 digits of Social Security ______Birth Date: Month ______Day ____ Year ______

Please make your check payable to VSIAS for $25 or have exact cash amount to be paid at the time of departure from the conference.

Registration Fees:

Registration Before June 10, 2016 1-Day $225 2-Day $375 3-Day $425

Tuesday Awards Luncheon Cost (Limited seating) $5

Registration After June 10, 2016 & On-Site 1-Day $250 2-Day $425 3-Day $500

Total Amount Paying$______

Credit for Attendance:VSIAS enjoys the privilege to be an education provider for a number of credentialing and academic organizations. Inherent in this privilege is the ethical responsibility that VSIAS accepts to ensure that attendance credits are awarded fairly and honestly. To this end, an individual must attend a minimum of 80 percent of a session to receive credit. VSIAS Faculty will take steps to ensure this is the case. We trust you will understand and support why there must be no exceptions to this requirement. Additionally, VSIAS will take required actions in those cases should an individual misrepresent membership or credentials status. VSIAS provides a professional learning experience and therefore has an ethical responsibility to ensure the good name of the Virginia Summer Institute for Addiction Studies as a reputable and credible conference. Thank you for your support in this matter.

Training Contact Hours provided by: NAADAC Education Provider: # 204

EACC/PDHs approved.

CEUs approved through Old Dominion University. Please bring a check payable to VSIAS for $25 or have exact cash available to pay at end of conference.

NASW-VA CE Approval for 19.5 contact hours.

Virginia Certification Boardapproved for 22.5 hours.

Payment Method

Federal Tax I.D. No. 65-1176624 and DUNS No. 962331331

There are three methods of payment.

1 - Personal or Agency Check: Check number: Amount of check:

2 - PayPal Payment:

If you pay by credit card, you may email your registration form. If you pay by check, please mail both the form and check together, so there is no delay in your receiving a confirmation for your sessions.

3 - Purchase Order # ______

PARTICIPANT NAME (LAST, FIRST) PLEASE PRINT:
Training Session Selection
MONDAY, JULY 11 AM SESSIONS – 8:30 - 11:45 AM
Keynote/Plenary Session
Nuckols, CC: Treating the Emerging Young Adult Alcoholic and Addict
LUNCHBOX SESSIONS - 12:00 - 1:00 PM
King, M: Adolescent Substance Use Treatment: Current Trends & Recommended Strategies
Cascio, L: Youth Choices, Decisions & Consequences
Mark Blackwell: Update-Peer Recovery Specialist Certification Process
MONDAY, JULY 11 PM SESSIONS – 1:15 - 4:30 PM
Nuckols, C C:Treating the Emerging Young Adult Alcoholic and Addict (More In-Depth Session)
Crozier, M: Behavioral/Process Addictions: Transforming our understanding of clients with addictions
Ortiz, S: Up In Smoke - Transforming Drug Therapy Using Hip Hop
May, J: Integrated Care: Transforming Your Organization for the Future
Liller, HRook, D: Recovery using the McShin Model
TUESDAY, JULY 12 EARLY AM SESSION 7:45 - 8:15 AM
Johnston, N: Morning Mindfulness
TUESDAY, JULY 12 AM SESSIONS – 8:30 - 11:45 AM
Plenary Session
Jackson, A: May the FORSE be with us: Building Trauma Informed Social Emotional Competence and Coping Skills with Adolescents Engaging in Substance Abuse
TUESDAY, JULY 12PM SESSIONS – 1:15 - 4:30 PM
Gillette, M: The ETHICS of Social Networking and Electronic Communication with Clients
Dmoch, R & Thompson, S: East Meets West: Emotional Freedom Techniques (EFT) for Substance Use Treatment
Basto, E:Addressing and Treating Addiction Through Mindful Practices: Art and Yoga Therapy
Fishman, M & Greenberg, D: "Recovery Warrior" A Therapeutic Video Game Intervention for Youth SUD
Porter, P & Hill, B.: HIV/AIDS: Transmission, Treatment Prevention Counseling for Substance Abusers
WEDNESDAY, JULY 13 EARLY AM SESSION 7:45 - 8:15 AM
Johnston, N: Morning Mindfulness
WEDNESDAY, JULY 13 AM SESSIONS – 8:30 - 11:45 AM
Plenary Session
Huysman, J: Emerging Trends in Boomer, Senior and Family Caregiver Addiction Protocols
WEDNESDAY, JULY 13 CLINICAL SUPERVISION 8:30 - 4:30 PM MUST ATTEND ALL DAY
Hall, D: Keeping Pace: Trends in Clinical Supervision
WEDNESDAY, JULY 13 LUNCHBOX SESSIONS - 12:00 - 1:00 PM
Beaver, J: REVIVE Training to lay people; Opioid overdose reversal through Naloxone-spray
Griffin, H: Time Line: The Process of Addiction and Recovery
WEDNESDAY, JULY 13PM SESSIONS – 1:15 - 4:30 PM
Fisher, M: Harm Reduction for High Risk Adolescent Substance Abusers
Johnston, N & Pritchard, R: Enabling: Personal, Professional, Institutional
Marzilli, L & Garrett, S: Opioid Specific Treatment: The Counseling Side of Medically Assisted Treatment
Muller, D & Sheafe, S: Trauma and Substance Use

Grab-n-Go Lunches Monday and Wednesday are included in your registration fee. Awards Luncheon Tuesday $5:

Monday Grab-n-Go: (select one) Regular Meal Vegetarian MealNo Grab-n-Go Lunch

Tuesday Awards Luncheon: Cost $5 (limited seating) Regular Meal Vegetarian Meal No Lunch

Wednesday Grab-n-Go:(select one) Regular Meal Vegetarian Meal No Grab-n-GoLunch