North Dakota Behavioral Health & Children And Family Services Conference

Registration Form

Attendee Registration

Please review the information below prior to completing your registration

All Attendees will be provided the virtual log-in information. For accurate event center planning, please select in-person attendee, if you plan to join us in Bismarck.
Upon submitting this registration, you will be asked to provide payment via Paypal or using a debit or credit card. Please have your form of payment ready as you cannot proceed with registration until payment information is entered.
A confirmation email will be sent for your registration and for your payment (if applicable). Please confirm the accuracy of your email address on the registration page AND on the bottom of the payment screen.
2nd Attempt - If you clicked “Next”, but didn’t complete the payment screen or received a confirmation email, please click here to follow the necessary steps to complete your registration.
To support the peer support workforce in North Dakota, we are offering a reduced conference rate for North Dakota Peer Support Specialists. Please fill out this application to determine eligibility for a reduced rate registration fee. If your application is approved the registration fee for the three-day conference will be $50. Do NOT submit your registration without receiving a discount code (if applicable) as you will be charged the full amount. Refunds may incur a PayPal fee.
If you have been provided a discount code, please confirm the amount that appears in green BEFORE clicking next. If you do not see the correct discount amount or you receive an error (highlighted in red), do not proceed as you will pay the full amount. Refunds may incur a PayPal fee. Contact Jill Walkinshaw Isaak for assistance with registration.

Attendee Registration

Registration Type

I plan on attending

In-Person

Virtually

First Name

Last Name

Email Address

Repeat Email Address

.edu address is required*

Please verify email address to ensure you receive all conference updates.

Mobile

Company

Zip Code

Title

Emergency Contact Name

Emergency Contact Phone Number

I am: *(check all that apply)

If you are employed by a Human Service Zone, please indicate which office:

If you are employed by Tribal Social Services, please indicate which office:

For Foster Parents Only: Please indicate which authorized licensing agent you are affiliated with:

Please select the university you attend:

Please identify the Division/Section you work for:

Packages

Payment Section

Registration Form

Attendee Registration

Attendee Registration

.edu address is required*

Please verify email address to ensure you receive all conference updates.

Please review all information above as it will be used for check-in and name badge printing.

If you are unable to pay using either of the provided options, please contact dhsbhd@nd.gov to register and complete the payment process.