2012 Meeting of the Minds Registration

Early registration deadline: March 30, 2012. Registration rates will double after this date.

Name:

Institution/Agency:

Title:

Phone Number:

Mailing Address:

City:

State:

Zip:

E-mail address:

Please select one of the following:

Will you be attending dinner on Thursday night?

Yes

No

Will you be attending the awards luncheon on Saturday?

Yes

No

Is your institution member affiliate of The BACCHUS Network who has paid BACCHUS membership fees for the 2012 year?

Yes

No

I don't know

Pre-Conference Workshops

Please indicate which workshop you are registering for. Remember to register early to secure your spot in the pre-conference workshops:

Half-day workshops. 2:00pm - 5:00pm, April 12.

Tackling Tobacco: Core Elements of an Evidence Based Tobacco Cessation Program.

SafeTALK

Empowering Bystanders: A Pre-Conference Especially for Students

DWI Statutes and Case Law (POST certified for Law Enforcement)

Ethics TOO: Right Way? Wrong Way?

I am not attending a half-day pre-conference workshop

Full-day workshop. 9:00am - 5:00pm, April 12

Assessing and Managing Suicide Risk

I am not attending a full-day pre-conference workshop

Special Training Session: Step UP! Train the Trainer: Creating a Powerful, Sustainable Bystander Intervention Program on Your Campus!

9:45am -12:00pm, Friday, April 13

I would like to register for the Step UP! Train the Trainer – Creating a Powerful, Sustainable Bystander Intervention Program on Your Campus! Session.

Fees

Total will appear on next page.

Full Meeting of the Minds Conference:

Students - $110

BACCHUS member institution students - $85

Graduate Students - $140

Professionals - $180

I am not attending the full conference (select if you would only like to attend a Pre-Conference session)

Pre-Conferences:

Half-day Pre-Conference - $25

BACCHUS member institutions Half-Day Pre-Conference - $0

Full-day Pre-Conference - $50

I am not attending a pre-conference

Payment Type

Please note the campus whose PIP funds you will be using:

Please enter the following Mocode information:

Special requests or accomodations:

Checks can be made out to: University of Missouri. Sorry, we cannot accept credit cards.

Please note: Refunds are not available for cancellation after March 30, 2012. Substitutions are allowed. Early registration ends at midnight on March 30^th. Effective March 31^th, 2012, all conferences will double. Please contact conference registrar, Joan Masters, with questions.

Any accessibility requests for persons with disabilities or special dietary needs should accompany this form. Please provide all meal requests before March 30, 2012 to ensure accommodation. Personal hotel room accommodation requests should be made directly with the Kansas City Airport Marriott when the reservations are made.

Address to submit payment:
Joan Masters
Wellness Resource Center
G202 MU Student Center
Columbia, MO 65211-5230
For questions related to the billing or registration process, please contact Joan Masters at 573-884-7551 or MastersJ@missouri.edu.

The next page will display your total cost. Please print the next page as a receipt.