School Health Spring Symposium Symposium Registration Registration (Before 3/1/2021) – $150, t-shirt guaranteedLate Registration (After 3/1/2021) – $150, no t-shirt 1 Attendee Information2 Field of Work3 Payment Name* First Last Organization*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneCellEmail* Field of Work*Professional Development certificates will be provided *Approved for Continuing Education credits by the Arkansas Board of Examiners in Counseling *Approved for Continuing Education credits for educators by the Arkansas Department of Education The Arkansas Department of Health is an approved provider of continuing nursing education by the Midwest Multistate Division, an accredited approver by the American Nurse Credentialing Center's Commission on Accreditation. *Nurses, if you require CNE's, please register in ATRAIN prior to attending Field of Work (choose one)*EducationMental/Behavioral HealthMedical/Nursing *Registration includes one year SBHAA Membership, t-shirt, conference materials, & lunchRegistration information*Registration ($150.00) (Before 3/1/2021)Late Registration ($150.00) (After 3/1/2021)Undergraduate/Graduate Student (must show current Student ID) ($75.00)T-shirt SizeXSSMMLXL2X3XDisclaimer: To ensure receiving a t-shirt registration must be complete by 3/1/2021.Payment Method*Credit/DebitPurchase Order (*must attach PO)Check by MailPurchase Order NumberCredit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Total $0.00