User Registration Please use this form to register, create an account and make payment for the Symposium. After payment you will receive an email to activate your account. Please enable JavaScript in your browser to complete this form.How did you hear about this event *Do you consider yourself a survivor of suicide (experienced the suicide of someone close)?YesNoExplain if you wishYour Name *FirstLastEmail *Cell PhonePhone numbers are collected to contact you in the event of an emergency cancellation, they are not shared.AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeUsername *Password *PasswordConfirm PasswordShort BioShare a little information about yourself.Organization InformationOrganization Name *Your Title *Organization Website URLPayment InformationCHL’s Cancellation PolicyThe cancellation of registration for the symposium may be made with no penalty up to one week prior to the start of the first day of the scheduled symposium. Except in the case of an emergency, registrant cancellation made less than one week prior to the start time of the first day of the scheduled conference or symposium will be deemed a “no-show”. No-shows for confirmed registrations will be assessed 100% of the fee for the symposium. Remember, you will have access to the symposium content after the event, even if you miss the live presentation.I agree to the cancelation policySingle Item *Price: $ 99.00Choose a Payment method *Credit CardCredit CardPaypalBilling Name *Billing Email *EmailConfirm EmailBilling Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCredit Card Payment *CardName on CardYou selected PayPal as your payment method. You will be re-routed to the PayPal payment page to complete your transactionMessageRegister