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MCEDSV 2019 Annual Conference - MDSVPTB support for funded programs

This registration form is for use by staff from MDSVPTB-funded agencies and federally recognized tribal organzations who are eligible to register with their support. Please carefully review the guidelines of MDSVPTB conference support for funded agency staff.

MCEDSV 2019 Annual Conference
Lasting Change
Wednesday and Thursday, May 22-23, 2019
Doubletree by Hilton - Dearborn, MI

Light breakfast, and lunch, are provided both days.
CEUs for Social Work are included at no cost with scholarship registrations.

MCEDSV 2019 Annual Conference Information Page

Your Contact Details

Name

First Name

Last Name

Name prefix or suffix? i.e. professional credentials or degrees earned; for example: JD, LMSW, and PhD.

This includes professional credentials or degrees earned; for example: JD, LMSW, and PhD.

Do you go by a nickname? (This will be printed on your name tag and all event lists and reports).

Your contact information & other stuff we need to know :)

Your Email:

Thank you for double-checking accurate entry. If your email address is entered with typos, unfortunately, you will miss important event-related details and messaging from us :(

Verify Email

Your Position/Title:

Full Organization/Agency Name

Thank you for providing the full organization name, (and acronyms are ok too). Please do not abbreviate or enter an incomplete organization name.

Organization/Agency Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Social Work Licensure # (CEUs for Social Work are included at no cost with scholarship registrations)

MCEDSV is an approved provider of CEUs for Social Work only. MCEDSV can only issue a CEU certificate if you provide your licensure # here, participate fully and follow complete sign-in instructions onsite at the event.

Do you have accessibility support needs or requests? Please share...

Meals and Dietary Requests

I can eat anything with no restrictions.

I would like to make a special dietary request (include severe food allergies).

*Important*

Regarding special dietary requests, please note ...

MCEDSV carefully selects venues with the best quality of service to accommodate the varying needs of our guests. Selected venues do the best job working closely with us to meet the broadest range of individual dietary and accommodation requests and that are within MCEDSV's budget limitations per funder guidelines for this event.

Offerings and ability to meet individual and specific requests vary from venue to venue, and individuals with very specific dietary requirements are advised to plan ahead and bring supplements and snacks that will ensure your needs are met.

FYI - meals served at all MCEDSV events will exclude fish and seafood – those items will never be on the menu ;)
If you should have questions about group meals provided at any event, please email registrations@mcedsv.org to inquire before the event.

Details of your meal option or dietary requests. Here you may indicate a REQUEST for a special meal option (i.e. vegetarian, gluten free) and share with us any additional notes including severe allergies.

Note about lodging with your conference supported registration...

MCEDSV makes your lodging reservations, if applicable, with Shanty Creek Resorts. You will be contacted by MCEDSV event staff within two business days to discuss your lodging needs. Please be sure you have carefully reviewed and fully understand the guidelines of the MDSVPTB support for your conference registration.

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MCEDSV 2019 Annual Conference - MDSVPTB support for funded programs

Your contact information & other stuff we need to know :)

To ensure your registration goes through, click "Submit" below.