Brochure         Workshop Information




Disaster Behavioral Health:
A Critical Response

Building Maine's Capacity to Respond

September 24-25, 2009
Please note new date
Skowhegan Community Center
Skowhegan ME 		October 7-8, 2009
Please note new date
University of Maine Farmington
Farmington ME 		November 5 - 6, 2009
Holiday Inn Express
Saco ME

Registration

  • Use this form to register for Disaster Behavioral Health: A Critical Response - Building Maine's Capacity to Respond. Complete the fields below and click on Submit Form at the bottom of the page. Fields marked with an asterisk are required.

  • Registration fee is $50 and includes: Program, Lunch/Breaks, and Continuing Education Credit. Individuals interested in joining the Maine disaster behavioral health response team are eligible to attend at no charge

  • If you prefer, you can download a registration form. This form can be mailed to AdCare Educational Institute of Maine, Inc., 75 Stone Street, Augusta, ME 04330 or faxed to 207-621-2550.

  • Registration Deadlines:
          September 30, 2009 (Farmington) - September 17, 2009 (Skowhegan)if no special accommodations are requested
          September 23, 2009 (Farmington) - September 10, 2009 (Skowhegan) if special accommodations are requested
          October 28, 2009 (Saco) - October 21, 2009 (Saco) if special accommodations are requested

  • Confirmation of Registration and site directions will be sent to you after the registration deadline.
  • We are looking forward to seeing you.

  • If you have any difficulties with this online registration form, please contact
  • Please submit a separate registration form for each person.
    		•

    *Name:
    *Email Address:
    Title:
    Agency:
    *Address:
    *City:
    *State:
    *Zip Code:
    Telephone:
    Fax:
    Please select Dates/Location..
    October 7 - 8, 2009 Farmington September 24 - 25, 2009 Skowhegan November 5 - 6, 2009 Saco  
    Please indicate payment method (fee is $50).
    Will Send
    Check         		Will Send
    Agency PO         		Will Pay at Registration Fee Waiver
    (Individuals who take this training with the intent of joining the Maine disaster behavioral health response team are eligible to attend at no charge.) Please check above for a fee waiver.         		 
    Special Accommodations
    The conference site is ADA compliant.
    Sign Language Interpreters, Assistive Listening Devices or other accommodations are available on request.
    Please request accommodations prior to September 23, 2009 (Farmington) - September 10, 2009 (Skowhegan)
    I request the following accommodation:
    Sign Language Interpreter
    Assistive Listening Device
    (Please specify type:)
    Other Accommodations
    (Please specify:)

    Additional Information:



    Maine Department of Health and Human Services
    Maine Center for Disease Control and Prevention
    Division of Public Health Systems
    Office of Public Health Emergency Preparedness


    For more information or to receive a brochure by mail or fax, please email:


    This web site is maintained by:
    AdCare Educational Institute of Maine, Inc.
    75 Stone Street, Augusta, ME 04330
    207-621-2549 (phone)
    207-623-0830 (TTY)
    207-621-2550 (Fax)