VOCAL Conference Registration Form

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2019 VOCAL Mental Health Recovery Conference, The Evolution of Us
May 20 and 21 at The Hotel Madison, Harrisonburg, VA

Email *

Name: *

One registration form per person, please.

Address: *

City/State/Zip: *

Area Code and Phone #: *

Special Requests

I require a gluten free diet

I require a vegetarian diet

I require an ADA room

I am sharing a room at the conference. I would like to share with this attendee:

I give consent for VOCAL to use my photograph on their website or newsletter without any additional contact. *

Yes

VOCAL offers a limited number of full and partial scholarships to those who meet certain income requirements for individuals paying their own registration. Scholarships are given on a first come, first serve basis. Please contact your CSB or other organizations you are affiliated with about sponsoring you before requesting a VOCAL scholarship. Overnight accommodations at the reduced or scholarship rates are reserved for those who live further than 60 miles from the event. Scholarship recipients agree to attend the VOCAL Annual Meeting on Tuesday, May 22nd, volunteer for 1.5 hours for the conference and complete the evaluation and survey in your registration packet.

Please check registration information that applies to you: *

To use a credit card, Paypal charges 2.9% plus .30 per transaction. VOCAL will split these fees.

$350 Full conference rate (shared room) for registrants with income over $3015/mo.

$40 Scholarship for all or part of the conference for attendees with income under $1006/mo.

$200 Reduced Rate full conference for registrants with income between $1006-3014/mo.

$100 One day conference rate for registrants with income over $3015/mo.

$75 Reduced Rate one day rate for registrants with income between $1006-$3014/mo.

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