WINTER EDITION | 2013 The Maryland Social Worker Page 15 2013 SOCIAL WORK MONTH ANNUAL CONFERENCE REGISTRATION FORM Thursday, March 21 & Friday, March 22, 2013 (#1712 – 6.5 Cat. I CEUs) Macro Social Work Pre-Conference Macro Social Work: The Solution to the Challenges of Today (5.5 or 7.5 Cat. I CEUs) Maritime Institute of Technology 692 Maritime Blvd Linthicum Hts, MD 21090 (410) 859-5700 Please Note: Continental breakfast and lunch are included in the registration fees for Thursday Pre-Conference both days Macro Social Work: The Solution to the Challenges of Today EARLY BIRD REGISTRATION FEES Please Note: Thursday Pre-Conference Sessions do not break out. Registrations must be received by 5:00 p.m. on Friday, March 1, 2013 All registrants will attend all Thursday workshops. ________ Thursday Pre-Conference Only–Early Bird ____ I will attend the optional movie, 4:30-6:30 p.m. $99 for NASW Members $139 for non-Members ________ Friday Annual Conference Only–Early Bird FRIDAY WORKshop Selections $99 for NASW Members Please indicate your first and second choices for each workshop. All workshops will $139 for Non-Members be filled on a first-come, first-served basis. We will attempt to honor each partici- pant’s selection, however, participants will be issued their second choice if a chosen ________ Both Thursday and Friday Conferences-Early Bird workshop is already full. $185 for NASW Members $250 for Non-Members Friday Morning Workshops 10:00 a.m. -12:30 p.m. REGULAR REGISTRATION FEES First Choice: ________________ Second Choice: ________________ Registrations received in NASW-MD office after 5:00 p.m., Friday, March 1, 2013 Friday Afternoon Workshops 2:00 p.m.-5:00 p.m. ________ Thursday Pre-Conference Only-Regular Rate $120 for NASW Members First Choice: ________________ Second Choice: ________________ $165 for Non-Members ________ Friday Annual Conference Only-Regular Rate $120 for NASW Members $165 for Non-Members PAYMENT METHOD _________ Both Thursday and Friday Conferences-Regular Rate $209 for NASW Members Check: __________ Charge: __________ $279 for Non-Members MasterCard_______ Visa________ Awards Luncheon Only: $30 Per Person ______________ Make Checks Payable to NASW-MD NASW Retiree/Gold Card Holders: $75 Each Day ______________ Credit Card Number: ____________________________________________ NASW Student Member: $50 Each Day _______________ Expiration Date: ________________________________________________ Please mail completed form to: Three-Digit Code on back of card: __________________________________ NASW-MD 5750 Executive Drive, Suite 100 Name as it appears on front of card: __________________________________ Baltimore, MD 21228 You may also register online at www.nasw-md.org. We do not accept fax registrations. Signature: ____________________________________________________ Name: _______________________________________________________ Today’s Date: __________________________________________________ Address (indicate home or work): ____________________________________ Comfort Zone Reminder City, State, Zip: ________________________________________________ Although every effort is made to have a comfortable temperature in the meeting rooms, Day Phone: ___________________________________________________ everyone’s comfort zone is different. Please bring a jacket or sweater in case the room is too cool for your comfort. Home Phone: __________________________________________________ Email: _______________________________________________________ NASW Membership #: ___________________________________________ Page 20 The Maryland Social Worker WINTER EDITION | 2013 Registration Form Please mail this form with your check made payable to NASW-MD, 5750 Executive Drive, Suite 100, Baltimore, MD 21228. Lunch is not provided for day-long workshops unless otherwise stated. If you would like to receive an email confirmation of your registration, please include your email address on this registration form. NASW-MD reserves the right to cancel any workshop for poor registration. Refunds for workshops canceled by NASW-MD shall be mailed within 3 weeks. Registrations MUST be received 2 business days/48 hours prior to program date or a late fee of $10 will be charged. Please see full refund/cancellation polices on the first page of the continuing education schedule. Workshop fee includes certificate. PLEASE NOTE WE DO NOT ACCEPT FAX REGISTRATIONS • THank YOU FOR YOUR coopeRATion • NASW-MD ReseRves THE RIGHT TO canceL woRksHops DUE TO Low REGisTRATion Please print legibly Name: ______________________________________________________ WINTER/SPRING 2013 Home Phone: __________________ Day Phone: _______________________ $______ 1718 Caring for Senior Citizens & Understanding Alzheimer’s (Branch C) $_____ 1708 Intro to Special Ed for School Social Workers (Baltimore) Address: _____________________________________________ ZIP______ $_____ 1729 Early Childhood Abuse and Juvenile Justice System (Baltimore) Email_________________________________________ (required for receipt) $_____ 1730 First Sunday Matinee White Oleander (Baltimore) $_____ 1719 Ethical Decision Making (Branch C) NASW#: ____________________________________________________ $_____ 1720 Resolving Trauma: Why They Kill (Branch C) $_____ 1732 First Sunday Matinee Extremely Loud & Incredibly Close (Baltimore) Total $________ Check amt. $________ (Make check payable to NASW-MD Chapter) $_____ 1721 Case Managing Today’s Client Village (Branch C) $_____ 1733 Ethics and Supervision in Clinical Social Work Practice (Baltimore) Credit card payment: Mastercard Visa $_____ 1731 Trauma and Attachment Disorder (Baltimore) Credit card number: _____________________________________________ $_____ 1722 Tripping Through the Brain/Body (Branch C) $_____ 1716 Ethical and Cultural Issues in a Healthcare Setting (Frederick) Expiration date: ______________________3-digit code___________________ $_____ 1717 Kids Charged as Adults (Frederick) $_____ 1734 First Sunday Matinee The Visitor (Baltimore) Name as it appears on the card: ______________________________________ $_____ 1723 Recovery Management: Strategic Interventions (Branch C) $_____ 1714 Diversity, Ethics, & Integrated Dual Disorders (Branch A-Southern MD) Signature: _____________________________ Today’s date: _____________ $_____ 1715 Shame, Guilt, and Fear (Branch A-Southern MD) $_____ 1727 A Framework for thinking Ethically (Branch D – Eastern Shore) Register Online–Save Time & Postage: MD-NASW offers a secure online registration procedure for its continuing education $_____ 1728 Buddhism and Psychotherapy (Branch D-Eastern Shore) courses! Go to www.nasw-md.org and click on Continuing Education for more infor- $_____ 1735 Is Anybody Out There Listening to Me? (Baltimore) mation or the Register Online icon on our homepage which will take you directly to the $_____ 1724 Ethical Dilemmas and the Digital Age (Branch C) 123 Sign-up online registration area! $_____ 1725 Grant Writing for Beginners (Branch C) $_____ 1736 First Sunday Matinee: The Impossible (Baltimore) Please Remember: $_____ 1737 Parenting the Disruptive Adolescent (Baltimore) You are ethically responsible for accurately reporting the number of continuing education $_____ 1726 From PTSD to PTG (Branch C) hours that you have earned. If you are attending a NASW-MD workshop and you are late, or have to leave early you are responsible for notifying the workshop coordinator. Your CE certificate will be adjusted to reflect the actual hours of attendance. Completing this QUesTions conceRninG REGisTRATion? registration form implies that you have been informed of this policy and your responsibility. CALL 410-788-1066 OR 800-867-6776 Directions to Workshop Locations NASW-Maryland Office Wheaton (Route 97); exit carefully (there is no merge area). Travel ½ mile and merge onto 85N for 1 mile 5750 Executive Drive, Suite 100 Go to the first traffic light and turn right onto Forest Glen Road. Turn left ont MD 355 North. Travel for 1.3 miles TRaveLinG FRom THE EasT: Upon entering Cambridge city Baltimore, MD • 410-788-1066 Follow several blocks to Holy Cross Hospital on the right. Turn left onto W 2nd Street limits, the second traffic signal will be Church Creek Road. Turn left Turn left onto Record Street at this signal. Remain on this road for 1.1 miles. Turn left on Woods FRom THE BALTimoRE BELTwaY I-695: Take exit 15A FRom THE NORTHeasT: Follow I-95 South toward Turn left onto W. Church Street. All Saints is on right. Road. Approximately 3/10 of a mile down this road, the hospital will for Route 40 East. Prior to 2nd traffic light, make a right Washington; merge to I-495 toward Silver Spring. Follow to be on your right. onto Ingleside Ave. (Day’s Inn and Checkers restaurant on Exit 31A, Georgia Avenue-Wheaton (Route 97 North); exit PARkinG: Free parking in lot behind church on Saturdays or right). Proceed about 1½ blocks (passing a church and carefully (there is no merge area). Go to the first traffic light park in garage for a small fee. Charlotte Hall’s Veteran’s Home cemetery). **Turn right onto Executive Dr. (the Beltway and turn right onto Forest Glen Road. Follow several blocks to 29449 Charlotte Hall Road West Corporate Center), then bear left (stop sign there) for Holy Cross Hospital on the right. UMBC Charlotte Hall, MD 20622 parking lot. The 5750 building faces the parking lot, next to 1000 Hilltop Circle Adoptions Together. FROM WasHinGTon SUBURbs: Take Capital Beltway to METRO: Montgomery County Ride On bus service is Baltimore, Maryland 21250 Maryland Route 5 (Branch