The New England School of Addiction Studies and The New England School of Prevention Studies is scheduled to take place
June 14 - 17, 2010 at St. Michael's College, Colchester, Vermont.
You will receive, BY EMAIL, a final confirmation, directions, and other information approximately a week prior to the school. You will receive an email from neias@neias.org, neias2@neias.org, or neias3@neias.org. It is suggested that you enter these 3 email addresses in your address book or designate as "safe sender" addresses. If you require a confirmation mailed by US Postal Service, please contact NEIAS.
To register online, fill out the form on this web page and complete the following steps:
Enter all registration information. Information required for all applications is marked with an *. If you do not complete these fields, your registration will NOT be sent to us and you will get an error message when you click on SUBMIT FORM TO NEIAS (if you receive an error message please review your application to be sure that all required fields have been completed). Other fields are required in individual situations. If we do not receive this information, your application will be put on hold and we will contact you for the information. To expedite your application, please read the form carefully.
Click on SUBMIT FORM TO NEIAS at the bottom of this page when you have completed your application.
If you change your mind, click on CLEAR FORM at the bottom of the page and no information will be sent.
If you wish to pay your deposit or tuition today by credit card or PayPal account, after you have submitted this registration, the "Registration Submitted Page" will have a link to proceed to our Shopping Cart, where you can complete that secure transaction.
Ms. Mr.
* First
Middle
* Last
* Last 4 digits of Social Security Number
* Month and Year of Birth
(M//Y)
AGENCY:
MAILING ADDRESS:*This is a:
Work Address
Home Address
*Street
Address
* City
* State
* ZIP
*Telephone
* Agency Phone
(If no agency, please enter "None".)
*
Email Address
* Alternate Email
(If you do not have an alternate email address, please enter "None".)
Fax
*
Emergency Contact
(name & relationship)
*
Emergency Contact
(phone)
COURSE SELECTION:
When choosing courses, refer to the detailed course descriptions on line. Carefully review the course descriptions, content levels, and target audiences for those courses that interest you. Please identify 1st, 2nd and 3rd choices by course number and name for each TRACK.
Every effort will be made to assign you to your first choice. Submit a completed registration form early to ensure that your first choice is available.
Course assignments are based on the date complete applications are processed.
Please note occasional circumstances beyond the control of the New England Institute may result in the cancellation of a small number of courses.
Optional Pre-Conference: Mon. AM Choose only Pre-Conference courses if you are taking optional Monday morning course for an additional $50..
*1st Choice (course #)
*2nd Choice (course #)
*3rd Choice (course #)
Track A: Mon. PM & Tues. all day Choose only A, AB, or ABC courses.
*1st Choice (course #)
*2nd Choice (course #)
*3rd Choice (course #)
Track B: Weds. all day Choose only B courses (unless AB/ABC)
*1st Choice (course #)
*2nd Choice (course #)
*3rd Choice (course #)
Track C: Thurs. all day Choose only C courses (unless ABC).
If attending partial program enter NA for each choice.
*1st Choice (course #)
*2nd Choice (course #)
*3rd Choice (course #)
SPECIAL ACCOMMODATIONS: The conference site has wheelchair access available; however, advanced notice is required. NOTE: Application deadline is April 16, 2010 for Sign Language Interpreter or CART requests. ASL interpreters, assistive listening devices or other accommodations available upon request. I request the following accommodations:
Sign Language Interpreter Assistive Listening Device
(Please specify type of Assistive Listening Device:)
Wheelchair Access
Other Accommodations
Please specify other - note any serious food allergies:
PAYMENT INFORMATION FOR ALL APPLICATIONS (INCLUDING SCHOLARSHIP APPLICANTS)
TUITION RATE (SELECT ONLY ONE RATE) Full Program (Monday - Thursday):
Commuter, $560
Single Bedroom, $850
*Double Bedroom, $750
Partial/Tracks A & B only (Monday - Wednesday):
Commuter, $485
Single Bedroom, $745
*Double Bedroom, $650
Attend One Track Course (Track A, B, or C):
Commuter, $245
Additional Housing Information:
First floor bedroom needed for medical reasons
Roommate Name
* All housing is in single bedrooms, charged at the single rate, unless you have a roommate. NEIAS will NOT match participants in double bedrooms unless they have requested each other.
NOTE: All rooms are traditional dormitory rooms, with shared bath, assigned in the order applications are processed.
OPTIONAL FEE: (NON-REFUNDABLE)
Sunday Night Stay in a Single Room, $75
Sunday Night Stay in a Double Room, $50
Attend a Pre-Conference Course on Monday morning, $50
Purchase a T-shirt, $10
Small
Medium
Large
X-Large
XX-Large
XXX-Large
No T-shirt
RESIDENTIAL: Housing on campus will be in traditional dormitory rooms, located in hallways. Shared restrooms with multiple bathroom & shower stalls will be located on each hallway. There are a limited number of rooms available on campus, which will be assigned by processed application date. Participants may reside on campus, or commute from a local hotel or from home. See application instructions for more details.
COMMUTER: This option is available to participants who are staying in a hotel or commuting from home to St. Michael's College and do not need a room on campus. The commuter rate includes tuition, CEUs, lunches and dinners (no breakfast) in the campus cafeteria as noted on reverse. The fee DOES NOT include lodging. Click here for a list of hotels and motels.
HOUSING NOTE: There is no smoking in the residence hall bedrooms. Smoking is permitted outside in designated areas only.
METHOD OF PAYMENT*
Please indicate how payment will be made:
Agency Purchase Order # for $
Agency Letter Authorizing Agency Billing for $
I am mailing a Check or Money Order for $ . Check # (Payable to NEIAS)
Credit Card or Paypal to be Charged $
If you wish to pay your deposit or tuition today by credit card or PayPal account, after you have submitted this registration, the "Registration Submitted Page" will have a link to proceed to our Shopping Cart, where you can complete that secure transaction.
I will pay this amount by 6/14/10.
If your agency is not being billed for the tuition in full, a deposit of $250 (or the difference between the tuition and the amount they are paying) is due immediately. Mail payment to the address at the bottom of this web page or complete credit card authorization above. The balance is due by 6/14/10.
Agency will pay this amount by 6/14/10.
If your agency is paying, please mail or fax a purchase order or agency letter authorizing billing to: NEIAS, 75 Stone Street, Augusta, ME 04330; Fax: 207-621-2550.
SCHOLARSHIP APPLICANTS ONLY
NOTE: This application is NOT a state scholarship application. To apply for a scholarship, follow your state's procedures.
I am sending a scholarship application to: (specify state agency)
NOTE: The amount of scholarship assistance varies among states. You are personally responsible for unpaid amounts by 6/14/10.
If a scholarship is NOT awarded:
Please withdraw my application.
I will pay my tuition.
My agency will pay my tuition.
My tuition will be paid by my agency and myself.
PAYMENT, CANCELLATION, AND REFUND POLICIES
PAYMENT POLICY: Applications should include complete information and be sent early to assure admission. Only applications providing complete payment information and accompanied by a $250 deposit - in the form of a check or money order (payable to NEIAS), credit card authorization, agency purchase order, or agency letter authorizing billing - will be processed. NESAS often receives more applications than it can accept. APPLICATION DEADLINE IS APRIL 30, 2010.
CANCELLATION POLICY
All cancellations must be received in writing at the New England Institute by the following deadlines. Written cancellations may be faxed (207-621-2550), e-mailed
or submitted by using the on-line NESAS cancellation form by the following deadlines:
May 21, 2010, Full Refund
May 25, 2010 before 4:30 p.m., $250 cancellation fee
From May 25, 2010 after 4:30 p.m., $500 cancellation fee
SPECIAL NOTE TO AGENCIES PAYING TUITION Registrations secured by purchase order or agency letter will be liable for the above cancellation and refund policy.
REFUND POLICY:
Optional fees are nonrefundable. Full tuition refunds will be issued if:
A written cancellation letter is received in writing at the New England Institute by May 21, 2010.
REGISTRATION SUBSTITUTION The New England Institute accepts substitutions for participants who cannot attend the conference. All substitutions must be received in writing by May 28, 2010. Written substitutions may be faxed (207-621-2550) or e-mailed . Please clearly state who is replacing whom. The substitute is required to send a completed NESAS application to the New England Institute at the time a written substitution is being submitted. Substitutes wishing to replace scholarship receipients MUST check with their state agency (or other scholarship source).
COMPLETING REGISTRATION: Include your $250 deposit . Your application will be set aside until a deposit by, check, money order, credit card, purchase order or written billing authorization is received. You will receive written confirmation of your acceptance, directions, and other information via email about two weeks prior to the school. If you require confirmation via United States Postal Service, please contact NEIAS.
I have read and understand all payment, cancellation, and refund policies pertaining to this registration.
You must click on the "Submit Form to NEIAS" button below to send your application. Wait for the message informing you that your application form has been sent successfully. That page has a link to our secure online shopping cart if you wish to pay your deposit or tuition today by credit card, debit card, or PayPal. It is a good idea to print this page for your records.
Fax or mail to the address at the bottom of this web page.
The application form is in Portable Document Format (PDF). You will need to use Adobe Acrobat Reader to view and print it. If you do not have this software, it can be downloaded free of charge at the Adobe web site.
New England Institute of Addiction Studies and AdCare Educational Institute of Maine
75 Stone Street,
Augusta, ME 04330
207-621-2549 (Phone)
207-623-1030 (TTY)
207-621-2550 (Fax)
AdCare Educational Institute of Massachusetts
5 Northampton Street, Worcester, MA 01605
510-752-7313 (Phone)
510-752-8111 (Fax)
