Brochure         Workshop Information




Disaster Behavioral Health:
A Critical Response

Building Maine's Capacity to Respond

September 8 - 9, 2010

Acadia Hospital
Bangor ME
September 30 - October 1, 2010

West Bath Fire Department
West Bath, ME
October 28 - 29, 2010

Atlantic Oceanside
Bar Harbor 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 8 - 9 Training at Acadia Hospital
              August 23, 2010 special accommodations
              August 30, 2010 registration

          September 30 - October 1 Training at the West Bath Fire Department
              September 13, 2010 special accommodations
              September 20, 2010 registration

          October 28 - October 29 Training at the Atlantic Oceanside
              October 7, 2010 special accommodations
              October 18, 2010 registration

    • 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 Date/Location.

    September 8 - 9, 2010
    Bangor
    September 30 - October 1, 2010
    West Bath
    October 28 - 29, 2010
    Bar Harbor         		 
    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 Special Accommodations date for specified trainings.
    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)