TLPCA Counseling and Therapy Summit Registration & Payment "*" indicates required fields Personal InformationName:* First Last Job Title: Organization: Primary Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email Address:* Enter Email Confirm Email Cell Phone:*Work Phone:Are you a National Certified Counselor (NCC)? Yes No Are you a first-time attendee to the TLPCA conference? Yes No Registration Designation:*Pricing Professional Member Student Member Retired Member Non-Member or Guest Member TNAMFT or TNAPT Member Volunteer Student InformationDegree:* Institution:* Anticipated Graduation Date:* MM slash DD slash YYYY TNAMFT/TNAPT InformationTNAMFT and TNAPT members will receive a 20% discount off the non-member price. To receive the coupon code, please email [email protected]. Your TNAMFT or TNAPT member number will be required to receive the discount.TNAMFT/TNAPT Member Number: Registration OptionsProfessional Member RegistrationProfessional Member*Full Conference includes 2 pre-conferences on Friday; all day Saturday. Private Practice, Suicide, Supervision, and Wellness pre-conferences are full. Pricing Full Conference Friday-only Pre-conference AM #1 - 9am-12pm (Ethics) Friday-only Pre-conference PM #3 - 1:30pm-4:30pm (Trauma) Saturday Only Professional Member Full Conference Price: Professional Member Friday: Ethics Price: Professional Member Friday: Private Practice Price: Professional Member Friday: Suicide Price: Professional Member Friday: Supervision Price: Professional Member Friday: Wellness Price: Professional Member Friday: Trauma Price: Professional Member Saturday Only Price: Total Student/Retired Member RegistrationStudent/Retired/Volunteer*Full Conference includes 2 pre-conferences on Friday; all day Saturday. Private Practice, Suicide, Supervision, and Wellness pre-conferences are full. Pricing Full Conference Friday-only Pre-conference AM #1 - 9am-12pm (Ethics) Friday-only Pre-conference PM #3 - 1:30pm-4:30pm (Trauma) Saturday Only Student/Retired/Volunteer Full Conference Price: Student/Retired/Volunteer Friday: Ethics Price: Student/Retired/Volunteer Friday: Private Practice Price: Student/Retired/Volunteer Friday: Suicide Price: Student/Retired/Volunteer Friday: Supervision Price: Student/Retired/Volunteer Friday: Wellness Price: Student/Retired/Volunteer Friday: Trauma Price: Student/Retired/Volunteer Saturday Only Price: Total Volunteer Member RegistrationNote that to receive their full discount, volunteers will need to enter in their discount code.Please enter in your discount code:* Volunteer*Full Conference includes 2 pre-conferences on Friday; all day Saturday. Full Conference: $25 Volunteer Full Conference Price: Non-Member, Guest Member, TNAMFT & TNAPT RegistrationNon-Member/Guest Member/TNAMFT/TNAPT*Full Conference includes 2 pre-conferences on Friday; all day Saturday. Private Practice, Suicide, Supervision, and Wellness pre-conferences are full. Pricing Full Conference Friday-only Pre-conference AM #1 - 9am-12pm (Ethics) Friday-only Pre-conference PM #3 - 1:30pm-4:30pm (Trauma) Saturday Only Non-Member/Guest Member/TNAMFT/TNAPT Full Conference Price: Non-Member/Guest Member/TNAMFT/TNAPT Friday: Ethics Price: Non-Member/Guest Member/TNAMFT/TNAPT Friday: Private Practice Price: Non-Member/Guest Member/TNAMFT/TNAPT Friday: Suicide Price: Non-Member/Guest Member/TNAMFT/TNAPT Friday: Supervision Price: Non-Member/Guest Member/TNAMFT/TNAPT Friday: Wellness Price: Non-Member/Guest Member/TNAMFT/TNAPT Friday: Trauma Price: Non-Member/Guest Member/TNAMFT/TNAPT Saturday Only Price: Total Friday Pre-Conference SessionsPrivate Practice, Suicide, Supervision, and Wellness are full.9am-12pm Session* Ethics 1:30pm-4:30pm Session* Trauma Leadership and SponsorshipI serve TLPCA in the following capacity: Regional Representative Board Member Committee Chair Volunteer Presenter Coupon CodeIf you are eligible for a registration coupon code (i.e. TLPCA leadership, TNAMFT/TNAPT) but have not already received one, please contact Robin Lee at [email protected]. Presenter 50% DiscountDiscount is off registration fees. $0.00 Regional Representative 50% DiscountDiscount is off registration fees $0.00 Board Member 50% DiscountDiscount is off registration fees $0.00 Committee Chair 50% DiscountDiscount is off registration fees $0.00 TNAMFT 20% DiscountDiscount is off registration fees. $0.00 TNAPT 20% DiscountDiscount is off registration fees. $0.00 Sponsor 100% DiscountDiscount is off registration fees. $0.00 Exhibitor 100% DiscountDiscount is off registration fees. $0.00 Admin 100% DiscountDiscount is off registration fees. $0.00 CSI 15% DiscountDiscount is off registration fees. $0.00 MHC 100% DiscountDiscount is off registration fees. $0.00 Cumberland Heights 100% DiscountDiscount is off registration fees. $0.00 LifeStance 50% DiscountDiscount is off registration fees. $0.00 Poster DiscountDiscount is off registration fees. $0.00 HiddenSubtotalWould you like to purchase additional lunch tickets for non-attendees?* Yes No Extra Lunch Ticket OptionYou may purchase lunch on either day for non-attendees.Friday Lunch Quantity Price: $25.00 Quantity Saturday Lunch Quantity Price: $25.00 Quantity PaymentTotal Payment Option* Credit Card Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Billing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code EmailThis field is for validation purposes and should be left unchanged. Δ Annual Conference2023 Summit Registration Schedule Conference Program Schedule of Events Pre-Conferences Keynote Saturday Session Titles Saturday Session Schedule Summit Materials & Documents Hotel Information Location & Parking Student Volunteers Summit Sponsors Summit Exhibitors CE Information
