INSTRUCTIONS
Complete the form below and click on "Submit" to send the form via e-mail. Please complete all parts so that we can list you properly on your nametag and in the attendees list, and so that you will receive all post-conference mailings.

If you'd like to send your registration by mail, please print this page and mail with payment to: NECON Annual Conference, c/o Policy Studies Incorporated, 675 Massachusetts Avenue, Cambridge, MA 02139.

Help us shape the 2009 NECON Conference and the New England prevention movement.
Please take a moment to complete this brief 6-question survey so that we may best address your areas of interest and learning preferences at this year's conference. Your feedback would be very much appreciated.

 I will attend the conference (see payment options below).

  I cannot attend the conference, but please keep me informed of future activities.

Name: REQUIRED
Credentials: (i.e., MD, RN, PhD)
Title:
Organization:
Mailing Address:
City:
State:
Zip:
Telephone (area code):
Fax (area code):
E-Mail Address: REQUIRED
Special Accommodations:

PAYMENT INFORMATION

 I will pay online using a credit card.

 I am sending you my check today for $55 made payable to NECON.

Check #
Mail to:
Necon Annual Conference, c/o Policy Studies Incorporated, 675 Massachusetts Avenue, Cambridge, MA 02139

Please help us control our costs by informing us if your plans change and you cannot attend. No-shows will be invoiced. Cancellations cannot be accepted after October 9, 2009 at 5:00pm.

* Registrations received after the deadline will be accepted on a space available basis, and registrants will not be included in the list distributed at the conference due to printing deadlines.