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.

How did you hear about this event *

Do you consider yourself a survivor of suicide (experienced the suicide of someone close)?

Your Name *

First

Last

Email *

Cell Phone

Phone numbers are collected to contact you in the event of an emergency cancellation, they are not shared.

Address

Address Line 1

Address Line 2

City

State

Zip Code

Username *

Password *

Password

Confirm Password

Short Bio

Share a little information about yourself.

Organization Information

Organization Name *

Your Title *

Organization Website URL

CHL’s Cancellation Policy

The 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 policy

Single Item *

Price: $ 99.00

Choose a Payment method *

Billing Name *

Billing Email *

Confirm Email

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Website