Conference Registration Form

APOSW’s 41st Annual Conference Registration
April 19-21, 2017 • Chicago, Illinois

(This form is for Credit Card Registrations Only)
Credit card payments are ONLY available through on-line registration.
If paying for your registration by check, US travelers’s checks, or US money orders:
please download and complete this version of the Conference Registration Form.(PDF)
A separate online registration must be completed for each registrant.

Email: info@aposw.org

Registration Information

First Name:

Middle Initial:

Last Name:

Degrees/Credentials:

Affiliation:

Department:

Badge Name:


(Your name as you wish it to appear on the conference badge - include credentials if desired)

First Time Attendee:

APOSW Past Board Member:

Mailing Address and Contact Information

Address:

Address 2:

City:

State/Province:

  (Enter 2-character abbreviation only. if US or Canada. E.g. NY)

Zip Code:

Country:

   (You must select a country.)

Work Phone:

 (###-###-####)

Fax:

 (###-###-####)

Email:

Conference Registration (Early Bird Pricing - Last Day is March 8, 2017)

PLEASE NOTE: Conference registration does not include APOSW membership fee.
To become a member or renew your membership, before you register for the conference,
click here for membership form and details. Membership must be current to qualify for member pricing.
If you are unsure of your membership status, email info@aposw.org for verification.

Note: Registration is not complete until payment is received in full.
All Conference Registration Fees include the cost of Continuing Education Certificates (CEUs).

 

(Selection Required)

 

Early Bird Discount

Until
3/08/17

After
 3/08/17

 

Full Conference Registration (Includes Celebration/Dinner)

2017 Full Member  (Degree in Social Work, Work in Pediatric Oncology):

$380

$480

 

2017 Associate Member (Non Social Work Degree):

$450

$550

 

2017 Student Member  (Enrolled in Undergraduate or Graduate Social Work Program):

$160

$260

 

2017 Student  (NOT a Member of APOSW):

$210

$310

 

2017 Retired Member:

$190

$240

 

2017 Non-Member of APOSW:

$575

$675

 

One-Day Conference Registration

2017 APOSW Member:

$150

$250

 

2017 Non-Member of APOSW:

$200

$300

 

Select a day:  Wednesday, April 19  |  Thursday, April 20  |  Friday, April 21

 

 

 

Roommate Locator

I would like assistance locating a:

Breakout Session Monitor:

Interested in being a breakout session monitor:

Breakout Sessions (Please select only one session per time slot and select ONLY ONE SEMINAR)

Download the Conference Brochure for Session and Agenda information (PDF)

Wednesday, April 19, 2017

SEMINAR
Select only one seminar below

All seminars begin at 10:15 AM

 

      Lunch is provided for SEMINAR 1 ONLY
      “Introduction to Pediatric Hematology Oncology Social Work”

      Special Dietary Requirement:   

 

Please select one session per breakout:

 

BREAKOUT 1
1:30 PM - 2:45 PM

 

 

 

 

Thursday, April 20, 2017

 

 

BREAKOUT 2
10:45 AM - 12:00 PM

BREAKOUT 3
1:45 PM - 3:00 PM

 

 

 

 

Friday, April 21, 2017

BREAKOUT 4
10:30 AM -11:45 AM

 

Special Events and Meetings

Please check the box at right to pre-register for the No Charge special events and meetings if you plan to attend.  Download the Brochure (PDF) for more information on Events and Meetings

I Will attend
(Check below)

Pre-Institute 1: Bowen Systems Theory (OR)

Tuesday, April 18, 2:00 PM - 5:00 PM

 

Pre-Institute 2: Writing for Publication & Peer Reviews

Tuesday, April 18, 2:00 PM - 5:00 PM

 

Networking Luncheon

Thursday, April 20, 12:00 PM - 1:30 PM

Region:    
(Required only if Luncheon is selected)

 

 

Special Dietary Requirement:    

 

 

Special Interest Group

Thursday, April 20, 3:15 PM - 4:45 PM

Interested in being a SIG facilitator:    

 

Select one SIG to attend:      
(Required only if a SIG is selected)

 

Roundtable Discussions

Friday, April 21, 12:00 PM - 1:15 PM

 

Select one roundtable to attend:
(Required only if a Roundtable Discussion is selected)

Special Dietary Requirement:    

 

 

 

 

 

 

 

 

Celebration/Dinner (Registration for the celebration/dinner is not available after April 5, 2017)

I Will attend
(Check below)

Celebration/Dinner is included in registration fee  

Thursday, April 20, begins at 6:30 PM

 

I will bring a Guest (additional cost of $80 per person)
Total will be added to your registration amount on the next page.

Number of Guests:

 

 

 

I Will attend
(Check below)

YOGA

Thursday, April 20, 6:30 AM - 7:30 AM

 

 

Friday, April 21, 6:30 AM - 7:30 AM

 

 

 

 

CITY WALK

Thursday, April 20, 6:30 AM - 7:30 AM

 

 

Friday, April 21, 6:30 AM - 7:30 AM

 

 

 

 

Photography Release
As part of your registration for the 2017 APOSW Conference, APOSW reserves the right to use videos, audio and photographs taken during the conference for future educational and marketing purposes.

Cancellation Policy
In order to accommodate unexpected emergencies, we will accept notification of cancellations up to 10 business days prior to the start of the conference (April 5th, 2017). Cancellations must be sent in writing via email to info@aposw.org. Refunds will be issued less a $100 processing fee.

NOTE: Pressing “Continue” button will allow you to review your choices and make changes before submitting your registration.

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