Scholarship Registration and Payment Your scholarship has been approved! Please use this form to pay your discounted rate, and create an account. Once we verify payment, your account will be activated. 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 wishHow many individuals are you registering today? *1Your Name *FirstLastEmail *Cell PhonePhone numbers are collected to contact registrants in the event of an emergency cancellation, they are not stored or sharedAddressAddress 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 URLPaymentCHL’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 policy *YesTotal *$ 0.00All attendee fees will only be accepted in U.S. Dollars.Billing Email *Choose a Payment method *Credit CardPaypalCredit Card Payment *CardName on CardYou selected PayPal as your payment method. You will be re-routed to the PayPal payment page to complete your transactionEmailRegister