Registrant details

First name: *

Last name: *

Company/Organization:

Title:

Email: *

Email (enter it again for validation): *

Phone: *

Address: *

City: *

State: *

Zip Code: *

Pronouns:

I will be submitting hours to my licensing board for Continuing Education Hours (CEH)

Please check all that apply to you that you are comfortable sharing:

Public Health Professional

First Responder

Crisis Worker

K-12 Educator

Primary Health Care Professional

Coalition Member

Community Member

College/University

Faith-based leader

Consumer/Peer

Advocate (affiliated with an advocacy organization)

Mental/Behavioral Health Care Professional

Person with Lived Experience of Suicide (thoughts, plans, attempts)

Person with Lived Experience of Suicide Loss

Caregiver for Person with Lived Experience of Suicide

Other:

You do not need to register for specific sessions. You will be able to attend any sessions you would like on the day of the conference. The conference will feature content related to crisis intervention, healthcare and behavioral health providers, the education system, coalition development, lived experience, peer support, and more.

The following questions are optional, but useful in helping our keynote speakers craft their presentations.

What are your expectations for this event? (max. 500 characters)

What would you like to learn or experience during the event? (max. 500 characters)

In-person Pre-conference Monday, June 15th, Black Business Hub

$50	General registration fee (Includes continental breakfast and lunch)
$0	Conference sponsors & preconference presenters
$0	I will not be attending the preconference

Virtual Conference (June 16 & 17th)

$25	General Conference Registration Fee
$15	Students
$0	This option is for individuals who do not have financial backing from an organization and would otherwise not be able to attend.
$0	Conference presenters and conference planning committee

Total Payment: