Virginia Summer Institute for Addiction Studies s1

Virginia Summer Institute for Addiction Studies 2013 Registration Form

Last Name: First Name: How name should appear on nametag: Title: Institution/Agency: Mailing Address: City: State: Zip Code: Phone: E-Mail: Affiliation: VADAP VAADAC SAARA SACAVA EVMS (Check all that apply) Credentials:

VSIAS Faculty/Board VSIAS Master Facilitator

Early Bird Registration: Through June 16, 2013 1-Day $140 2-Day $310 3-Day $335 Regular Registration: June 17 – July 8, 2013 1-Day $165 2-Day $375 3-Day $400 Student*: Through July 1, 2013 1-Day $100 2-Day $200 3-Day $255 Active Duty Military**: Through July 1, 2013 1-Day $115 2-Day $240 3-Day $265 On-Site Registration***: July 15 – 17, 2013 1-Day $175 2-Day $400 3-Day $435 * You must validate your student status. "I am a active student in a degree seeking program." ** You must send a copy of your Military ID with registration. *** On-Site Registration payable by check only. No cash or credit cards.

Payment Method

Federal Tax I.D. No. 65-1176624 and DUNS No. 962331331

There are three methods of payment.

1. Personal or Agency Check: Check number: Amount of check:

2. Credit Card (VISA, MasterCard, American Express, Discover only) via PayPal (not on-site)

3. Purchase Order P.O. # Training Session Selection

Select only 1 of the 2 packages below. Note: Some packages and sessions have limited enrollments and you will be registered on a first-come, first-enrolled basis. For complete session title and name of speaker, as well as any registration requirements and pre-requisites, please visit the VSIAS website @ www.vsias.org.

PACKAGE ONE: Clinical Supervision Foundations Prerequisite: Participants MUST complete the 14-hour on-line course prior to attendance at the conference. Clinical Supervision Foundations with Erin Johnson and Sandy Kanehl Tuesday and Wednesday: 8:00 - 11:45 AM and 1:00 - 4:45 PM Must attend all sessions to be given credit. If you are attending all 3 days, on Monday, you may attend the Keynote Session and one session in the afternoon. Please select your Monday sessions below. MONDAY, JULY 15 AM SESSIONS – 8:30 - 11:45 AM Keynote Session Darryl Inaba, Pharm.D.: Developments in Addiction Treatment: Understanding the Neuroscience Rationale LUNCHBOX SESSIONS - 12:00 - 1:00 PM Marjorie Yates: Empowerment vs. Deflation: Early Recovery Strategies That Work Idean J. Fortune, II: Overview of Trauma and Addiction: Trauma Assessment MONDAY, JULY 15 PM SESSIONS – 1:15 - 4:30 PM Simone Lambert: Adolescent Addiction Prevention: Strategies for School/Community Susie Mullens: Tech Support: Using Technology to Support Ongoing Recovery Gary Munn, M.D. and Debbie Forsythe: Development & Clinical Supervision of Multidisciplinary Teams Martha Early, Ph.D.: Bridging the Gap for Integrated Care Sandy Kanehl: Treating Tobacco Dependency: Who can do what and get reimbursed? WEDNESDAY LUNCHBOX SESSIONS - 12:00 - 1:00 PM Ron Pritchard: Recovery Oriented System of Care (ROSC) - What's the Buzz? Cara Marinucci: Complimentary Treatment Techniques: NADA Acu-detox and Integrative Therapies

PACKAGE TWO: A LA CARTE SESSIONS: PLEASE SELECT BOTH AM AND PM SESSIONS MONDAY, JULY 15 AM SESSIONS – 8:30 - 11:45 AM Keynote Session Darryl Inaba, Pharm.D.: Developments in Addiction Treatment: Understanding the Neuroscience Rationale MONDAY LUNCHBOX SESSIONS - 12:00 - 1:00 PM Marjorie Yates: Empowerment vs. Deflation: Early Recovery Strategies That Work Idean J. Fortune, II: Overview of Trauma and Addiction: Trauma Assessment MONDAY, JULY 15 PM SESSIONS – 1:15 - 4:30 PM Simone Lambert: Adolescent Addiction Prevention: Strategies for School/Community Susie Mullens: Tech Support: Using Technology to Support Ongoing Recovery Gary Munn, M.D. and Debbie Forsythe: Development & Clinical Supervision of Multidisciplinary Teams Martha Early, Ph.D.: Bridging the Gap for Integrated Care Sandy Kanehl: Treating Tobacco Dependency: Who can do what and get reimbursed? Idean Fortune, II: Trauma and Addiction: Trauma Assessment TUESDAY, JULY 16 AM SESSIONS – 8:30 - 11:45 AM David Austin Sky: Hearing the Unheard Story (continued in PM) Henry Morris, Ph.D.: Practical Aspects of Ethical Dilemmas Carmen Greiner and John Childress, Ph.D.: DSM-V: Changes to Substance Use & Other Adult Emotional Disorders (continued in PM) J. Patrick Slifka and George Young: Prescription Drug Epidemic (continued in PM) Sandy Downey: Intermediate Motivational Interviewing (continued in PM) TUESDAY, JULY 16 PM SESSIONS – 1:15 - 4:30 PM David Austin Sky: Hearing the Unheard Story (continued from AM) Carmen Greiner and John Childress, Ph.D.: DSM-V: Changes to Substance Use & Other Adult Emotional Disorders (continued from AM) J. Patrick Slifka and George Young: Prescription Drug Epidemic (continued from AM) Sandy Downey: Intermediate Motivational Interviewing (continued from AM) Katherine Fisher: Protecting You and Your Data in Today's Digital Environment L. Beth Gadkowski, M.D./Geraldine Stott, M.D.: WEDNESDAY, JULY 17 AM SESSIONS – 8:30 - 11:45 AM Kristine Nutt: Bath Salts, Synthetic Marijuana, and the New Designer Drugs Michael Weaver, M.D.: SBIRT: What It Is and How to Start Doing It (continued in PM) Gerard Schmidt: Why me? Why the Addiction Treatment Profession? Denise Hall: Advanced Motivational Interviewing (continued in PM) WEDNESDAY LUNCHBOX SESSIONS - 12:00 - 1:00 PM Ron Pritchard: Recovery Oriented System of Care (ROSC) - What's the Buzz? Cara Marinucci: Complimentary Treatment Techniques: NADA Acu-detox and Integrative Therapies WEDNESDAY, JULY 17 PM SESSIONS – 1:15 - 4:30 PM Michael Weaver, M.D.: SBIRT: What It Is and How To Start Doing It (continued from AM) Denise Hall: Advanced Motivational Interviewing (continued from AM) Lisa Marzilli, Pharm.D.: Part 1: Designer Drugs, Part 2: Pharmaceutical Methadone and Buprenorphine Emily Basto: Application of Yoga and Art Techniques to Trauma Reduction – BRING YOUR YOGA MAT Bianca Waechter, Ron Pritchard, David Semanco and Patrice Porter: Recovery Workforce Development

Grab-n-Go Lunches are included in your registration fee. Please select below:

Monday Grab-n-Go Lunch (select one) Regular Meal Vegetarian Meal No Grab-n-Go Lunch Monday Plated Meal (select one) Regular Meal Vegetarian Meal

Tuesday Grab-n-Go Lunch (select one) Regular Meal Vegetarian Meal No Grab-n-Go Lunch OR Awards Luncheon (select one) Regular Meal Vegetarian Meal Not Attending Awards Luncheon (limited seating)

Wednesday Grab-n-Go Lunch (select one) Regular Meal Vegetarian Meal No Grab-n-Go Lunch

"Drunk With Hope In Chicago" ~ Tuesday, July 16 6:30 PM

Comedian Tara T. Handron Will Attend ** Language may be offensive.

Credit for Attendance

VSIAS enjoys the privilege to be an education provider for a number of credentialing and academic organizations. Inherent in this privilege is the ethical responsibility that VSIAS accepts to ensure that attendance credits are awarded fairly and honestly. To this end, an individual must attend a minimum of 80 percent of a session to receive credit. VSIAS Faculty will take steps to ensure this is the case. We trust you will understand and support why there must be no exceptions to this requirement. Additionally, VSIAS will take required actions in those cases should an individual misrepresent membership or credentials status. VSIAS provides a professional learning experience and therefore has an ethical responsibility to ensure the good name of the Virginia Summer Institute for Addiction Studies as a reputable and credible conference. Thank you for your support in this matter.

Training Contact Hours provided by: NAADAC Education Provider: # 204 NAADAC Education Provider # 204 SACAVA Educational Providership # 06-04-05 SACAVA is a member board of the International Certification & Reciprocity Consortium (IC&RC)