21st Century Forensic Practice - National Organization of Forensic
Transcription
21st Century Forensic Practice - National Organization of Forensic
21st Century Forensic Practice: Moving Beyond Cultural Competence 31st Annual Conference of the National Organization of Forensic Social Work July 25-27, 2014 Fordham University Lincoln Center Campus New York City Conference Goal: Advancing Forensic Practice: Promoting Innovation Worldwide In this century of changing demographics and policy and system reform, this year’s NOFSW conference will feature inter-professional learning opportunities on how to integrate cultural competence with justice in clinical, organizational, community, and policy practice. This year’s conference will advance a new century of cultural justice, dignity, respect, and acceptance for all persons. Many forensic populations, such as racial and ethnic minorities, at-risk youth, the elderly, veterans, immigrants, LGBTQ persons, persons with disabilities, or those living in poverty or communities of violence often lack access to quality services and cultural justice. Conferences attendees will increase their knowledge, values, and skills for working with forensic populations in healthcare, social service, and legal settings, including the courts and corrections. The conference also includes the unique opportunity for attendees to attend field visits to innovative local and global organizations that advance cultural justice, live performances of the use of the arts for healing and rehabilitation, a prison art show, and film screenings with follow-up discussions with film directors. This year’s conference presentations also will be considered for our upcoming published book of conference proceedings or eligible for publication in the Journal of Forensic Social Work. Who Should Attend? This conference is targeted to practicing Social Workers and related professionals who are working in any way related to legal issues and litigation, both criminal and civil. Social workers with little or no forensic practice experience, related professionals with little or no social work education and experience and students may find some of the sessions advanced but useful. Continuing Education: Each workshop will be awarded CEUs based actual contact hours. Continuing education units (CEU’s): up to 19 hours for attendance will be provided for conference attendees. General membership meetings and introductory sessions are not eligible for CEUs. Attendees are required to attend the full session, sign in for each session as well as complete and sign the evaluation form for each session they attend. Licensees should reference their state’s continuing education requirements for specific requirements and restrictions. CEU certificates will be awarded and mailed to attendees within 30 days of the completion of the conference. Grievances must be submitted in writing to NOFSW’s postal mail address or electronically to [email protected]. All grievances will be reviewed by the NOFSW Social Worker Consultant and may be appealed to the NOFSW Executive Council. Conference Location and Hotel Accommodations: The conference itself will be held at the Fordham University Lincoln Center campus at 113 W. 60th Street, New York, NY 10023. There are a variety of hotels in the midtown Manhattan section of New York CIty. A list of hotels that offer discounts to attenees who are visiting Fordham University can be found at our website: http://nofsw.org/?page_id=837 . Program Calendar Note: Preliminary Schedule subject to change. Thursday, July 24, 2014 8:30 AM - 5:00 PM Queer Justice: The Intersection of LGBTQ Issues and Criminal Justice, A special pre-conference cultural justice seminar: Queer Justice: The Intersection of LGBTQ Issues and Criminal Justice will feature local and national experts and include a field visit to a LGBT mental health service agency and reentry program. Assemblyman Danny O’Donnell will be the luncheon speaker. Note: This event will be held at Long Island University, 1 University Plaza, Brooklyn, NY 11201. See NOFSW website for directions. 6:00 - 9:00 PM Social Work Rising: Empowering Ourselves and Our Profession for a New Era of Cultural Justice, Tina Maschi, PhD, LCSW, ACSW; Associate Professor, Fordham University Graduate School of Social Service; President, National Organization of Forensic Social Work; Executive Director, Be the Evidence Project; Fellow, New York Academy of Medicine; Kathleen Otte, Regional Administrator, Regions I, II and III, U.S. Administration for Community Living, “Advancing Momentum: Social Work Leadership in Aging and Underserved Populations” Note: This event will be held at Long Island University, 1 University Plaza, Brooklyn, NY 11201. See NOFSW website for directions. Friday, July 25, 2014 9:00 AM - 7:00 PM Registration 10:00 AM - 2:00 PM Optional Site Visit to the The Social Service Board at the New York Society for Ethical Culture. Services include televisiting communication of incarcerated parents with their children, advanced senior empowerment programs, homeless women’s sheltering, soccer play for urban Hispanic children, quality schools for formerly incarcerated children, psychiatric care for disaster victims, historical education exhibits, exhibitions for homeless artists. Walking distance from Fordham University, Two West 64th Street, Suite 505. 1:00 PM - 3:00 PM Welcome and Keynote Presentation: Children’s Rights To Be Heard, Shirley Gatenio Gabel, PhD, MSW. Dr. Shirley Gatenio Gabel is a long-time advocate for children. Her diverse experiences include directing public policy analyses for government and not-for profits, lobbying, and organizing community efforts. She helped create and managed the Internet-based Clearinghouse on International Developments in Child and Family Policies at Columbia University. Dr. Gatenio Gabel was appointed to the Council on Global Learning, Research, and Practice, CSWE Commission on Global Social Work Education. 3:15 PM - 3:55 PM A1A Justice Denied: Working with Exonerated and Wrongfully Convicted People, Carl Mazza, DSW, LMSW 3:15 PM - 3:55 PM A2A The School-to-Prison Pipeline: Implications for 21st Century Forensic Practice, Susan McCarter, PhD, MS, MSW 3:15 PM - 4:45 PM A3 Parents Trapped In Family Court: The Complicated Web of Culture, Race, and Class in NYC Brenda Zubay, LMSW; Milinda Kakani, MS, JD 3:15 PM - 4:45 PM A4 Where Forensic Social Work Begins: An Introduction to Legislative Advocacy, Christine Limone, MSW, LCSW; Shannon Lane, MSW, PhD 3:15 PM - 4:45 PM A5 Treating Mentally Ill Offender in an Inpatient Setting, Eileen Klein, PhD, LCSW, MS, ACSW 4:05 PM - 4:45 PM A1B Opportunities and Challenges in Protecting the Rights and Best Interests of Vulnerable People - Forensic Social Work in the Context of Public Advocacy, Patricia Mackey, MSS. 4:05 PM - 4:45 PM A2B Advancing Culturally Responsive Juvenile Justice and Delinquency Prevention Initiatives through a Comprehensive Continuum of Community Care, LaKeesha Woods, PhD 5:00 PM - 5:40 PM B1A Crossing Systems: Advocating for Adolescents and Young Adults Involved with both the Child Welfare and Juvenile or Criminal Justice Systems, Jessica Warner, LMSW, MA 5:50 PM - 6:30 PM B1B Out of Sight, Out of Mind: Addressing the Reality & Uniqueness of Female Child Sexual Offending in the US, David McLeod, PhD, MSW 5:50 PM - 6:30 PM B2B Listening to Fathers—The Dangers of Gender Stereotyping in Child Protection Work. Findings from a Scottish Practitioner Research Project, Nick Smithers, MA, MSW. 5:00 PM - 6:30 PM B3 Criminal Justice and Desistance: A Paradigm toward Change, Elizabeth Allen LCSW, PhD 5:00 PM - 6:30 PM B4 Defense without the Defendant: Rethinking and Challenging Language in the Courtroom through Holistic Advocacy, Elizabeth Keeney LMSW, MPA; Robyn Mar, Esq. 6:30 PM - 8:00 PM Welcome Reception with entertainment by Bobbi DiBlasio, “A Taste of Greenwich Village.” DiBlasio has been inspired by the likes of Bob Dylan, Tom Petty, The Byrds and numerous others. This Acoustic 12 String Guitar Singer-Songwriter creates a distinctive, stimulating mix between blues, rock and folk. DiBlasio has opened for New Riders of The Purple Sage at BB Kings, NYC, Gil Parris at BB Kings, NYC, Blues Traveler in Tappan, NY, to name a few. Bobby’s original, creative style of music is welcomed by all spectrums of listeners. Saturday, July 26, 2014 7:00 AM - 4:00 PM Registration 7:30 AM - 8:30 AM Continental Breakfast sponsored by Routledge Journals, Taylor and Francis Group, publishers of the Journal of Forensic Social Work 8:00 AM - 8:30 AM Presentation of Sol Gothard Award to Patricia Brownell, PhD, LMSW 8:30 AM - 10:00 AM Keynote Presentation: Finding the Place for Cultural Humility in the Healing Process, Robert Ortega, PhD, Associate Professor, University of Michigan School of Social Work. A cultural humility perspective is fundamentally geared toward acknowledging the limitations of cultural knowledge beyond self-knowledge. Through cultural humility, cultural stereotypes and culture-bound assumptions about specific cultures and cultural identities are actively and critically examined. Helping professionals are challenged to learn to identify and build on assets and adaptive strengths of child maltreatment victims and their families, inclusive of their intersectional, cultural self-definitions. This presentation advocates for engaging in culturally responsive practice inclusive of cultural humility that recognizes the unique contributions that victims and their families can make in the child maltreatment recovery process. 10:30 AM - 11:10 AM C1A A Description of Jail-Based Competency Restoration Program for Male Inmates, Louisa Ellis, LCSW, LICSW 11:20 AM - 12:00 PM C2B Hope for Children Condemned to Die in Prison: The Social Worker’s Role on the Legal Team, Maria Morrison, MSW, LCSW 10:30 AM - 11:10 AM C3A Forensic Social Workers as Expert Witnesses: Do the Courts as a Host Environment Warp Social Work Values and Ethics? Dana Prescott, JD, MSW 11:20 AM - 12:00 PM C3B Organizational Factors Affecting Burnout Among Forensic Interviewers, Christina Chiarelli-Helminiak, MSW 10:30 AM - 12:00 PM C4 Forensic Social Work (FSW) in the 21st Century: A Replication/Expansion of a 1998 Survey of Schools of Social Work Accredited by CSWE, Ira Neighbors, DSW, LCSW, MSW; Jay L. Hedgpeth, PhD, RSW, MSW 10:30 AM - 12:00 PM C5 Best Practices for Forensic Interviews of Sexual Abuse Allegations, Susan Robbins, PhD, LCSW 10:30 AM - 12:00 PM C6 Psychosocial Autopsies: An Examination of High-Profile Cases and Recommendations for Forensic Social Work Practice, Stacey Hardy, PhD, JD, LCSW; Robert W. Mulligan, MPS, R-LCSW 10:30 AM - 12:00 PM C7 Extreme Hardship: Hispanic Children and Deportation, Russell Bader, LCSW 12:00 PM - 2:00 PM Lunch on your own. 2:00 PM - 2:40 PM D1A From Cell Blocks to City Blocks: The Experiences of Carceral Involvement among Individuals with Serious Mental Disorders, Leah Jacobs, MA, MSW 2:00 PM - 2:40 PM D2A Law and Order: How a School of Social Work and an Urban Police Department Teamed Up to Serve Victims of Domestic Violence, Julie Ann Drake, JD, MSW, MA; Seanté A. Hatcher, LCSW-C 2:50 PM - 3:30 PM D1B A Proposed Clinical Screening Tool for Severe and Fatal Violence by Persons with Serious Mental Illness, Billy Chan, PhD, RSW; Maria Shehtman, MS 2:50 PM - 3:30 PM D2B Reducing Domestic Violence Through Effective Batterer Intervention Programming, Nada Yorke, LCSW; Bruce D. Friedman, PhD, ACSW, CSWM, LCSW 2:00 PM - 2:40 PM D3A Psychosocial Rehabilitation in Australian Prison Hospitals, Sarah Harvey, St Vincent’s Correctional Health, Melbourne, Australia 2:50 PM - 3:30 PM D3B Believing in Second Chances: Social Work Services under the Mandatory Treatment Order in Singapore, Roger Tan, B Soc Sci, MSW 2:00 PM -3:30 PM D4 Pretrial Services and Bail Funds - Increasing Access to Justice, Norma Wassel, MSW, LICSW; Alyssa Work, Esq. 2:00 PM -3:30 PM D5 Racial and Cultural Disparities in the Assessment and Treatment of Juvenile Sex Offenders, George Leibowitz, PhD, LICSW; Claire E. Gilligan, PsyD 2:00 PM -3:30 PM D6 Cultural implications with Competency to Stand Trial. A look at evaluation and restoration through a case study in Connecticut, Michael Genovese, MSW, LCSW 2:00 PM - 3:30 PM D7 Assisting Van Winkle: Developing a Community Re-Entry Program for Long-Term, Geriatric Prisoners, Rebecca Bowman-Rivas, LCSW-C; Elizabeth Smith, MSW, LGSW 3:45 PM - 5:15 PM E1 A Strategy for the Assessment and Management of Mentally Disordered Offenders within the Probation Board for Northern Ireland, Geraldine O’Hare, Chartered and Registered Forensic Psychologist 3:45 PM - 4:25 PM E2A Social Work and Juvenile Justice: Innovation through Partnership, Mandi Fowler, LCSW, PIP; Debra Nelson-Gardell, PhD, LCSW 4:35 - 5:15 PM E2B Increasing Alternative Sentencing in the Juvenile Justice System Through a Partnership Between Public Defenders and Social Workers, Lynn Geurin, Ph.D., LCSW Patricia Brownell 3:45 PM - 5:15 PM E3 Community Mediation as a Forensic Social Work Tool: National Trends in the Use of Community Mediation in Legal Systems, Daniel Kos, MA; Brad Heckman, MA 3:45 PM - 5:15 PM E4 Polyvictimization in Later Life: Forensic Findings and Implications, Patricia Brownell, PhD, LMSW; Bettye Mitchell, MA; Holly Ramset-Klawsnik, PhD, LMFT, LCSW 3:45 PM - 5:15 PM E5 Online-Peer-Counselling - (New) Media Based Aftercare-Management for Juvenile Delinquents, Christina Enders 3:45 PM - 5:15 PM E6 Becoming Culturally Competent in an Incompetent World - A Call to White Folks, Frances McClain, MA, LCPC, PhD Candidate, Lisa Salvadore, LCSW, LCPC, CADC 3:45 PM - 5:15 PM E8 Using Qualitative and Mixed Methods in Health Research for Practice and Policy Reform, Tina Maschi, PhD, LCSW, ACSW; Mary Beth Morrissey, PhD, MPH, JD 5:30 PM - 6:30 PM Poster Presentations and Reception Poetry in Street-Level Prostitution, Marie Bailey-Kloch, MSW, LCSW-C School to Prison Pipeline: A Primer, Joseph Graham and Abbe McCarter Beyond Cultural Competence: Understanding the Factors that Influence Interdisciplinary Competence and Collaboration, Barrett Bonella, PhD, LCSW Double Jeopardy: Cumulative Adversity and Constrained Support among Incarcerated Parents, Sharon Borja, MSW Secondary Trauma, Venise Burwell MSW, LCSW Stop, Question and Frisk: Unconstitutionality, Racial Profiling and Healing, Khalil Cumberbatch, MSW Student The Impact of Financial Inequality on Parenting Time in Family Court, Kathryn Dixon, MSW, LMSW, LCSW Hepatitis-C and HIV/AIDS Risk Associations with Incarceration for Homeless Latino Injection Drug Users, Taylor Hall, MA Aging in Place in the Prison System, Charlene Lane, PhD, LCSW-R; Michele Bratina, PhD Written Advocacy in Criminal Defense: Gathering Stories, Knowing Your Audience and Tracking Outcomes, Brittany Larson, LMSW Individual and Social Structural Trauma and Well-Being among Older Adults in Prison: Strategies for Human and Prisoner Rights Advocacy, Tina Maschi, PhD, LCSW, ACSW Injustice for All: The Prosecution of 16-Year Olds as Adults in Criminal Court, Carl Mazza, DSW, LMSW Islamophobia and Mental Health Issues in the American Muslim Community, Samira Mohmand The National Defense Authorization Act and Guantanamo Bay, Samira Mohmand Multi-Cultural Sensitivity Advantage or Disadvantage in Identifying Child Abuse, Adi Pachter-Alt, MSW Role of Social Work in Professional Collaboration: Guardianship for Individuals with Intellectual Disabilities, Tara Regan Foundations to Adoption of Trauma Informed Care: Results of a Needs Assessment for a Youth Residential Treatment Facility, Erynne Shatto, MS; Sarah Fucillo, BA, BS; Valerie Bryan, MSW, PhD; James R. Stefurak, PhD The Ramifications of Mass Incarceration, D’Nicole Tangen, BA Inmates Medically Paroled to Skilled Nursing Facilities: An Opportunity for Advocacy, Rachel Tate, MSW A Review of Social Work Roles in Prisons When Working with Offenders with Mental Illness and/or Substance Use Disorders, Hiroki Toi, MSW 6:30 PM - 7:30 PM Forty Years Later: Why Hasn’t Elder Abuse Also Been In the Spotlight? Robert B. Blancato, MPA, President of Matz, Blancato, & Associates. Bob is the National Coordinator of the Elder Justice Coalition, non-partisan, 680 member organization. Approximately forty years ago, child abuse prevention legislation began receiving funding. Today, elder abuse prevention is still under-recognized and poorly funded. This session will examine the evolution of elder abuse prevention as compared to child abuse prevention and the lessons that the elder justice movement can learn from the worlds of child abuse prevention and domestic violence prevention, including ways that these movements can work together. a 7:30 PM - 9:00 PM Figures in Flight Released. Performance by Rehabilitation Through The Arts, RTA was founded in Sing Sing in 1996. Today, we work in five New York State prisons with innovative programs in theatre, dance, creative writing, voice and visual art. RTA is dedicated to using the creative arts as a tool for social and cognitive transformation behind prison walls. RTA changes lives! Sunday, July 27, 2014 7:00 AM - 3:00 PM Registration 8:00 AM - 9:00 AM Continental Breakfast 9:00 AM - 9:40 AM F1A Importance of Distinguishing Substance Use Disorder in DSM 5 from Substance Abuse and Dependence in DSM IV, Lloyd Lyter, PhD, LSW 9:50 AM - 10:30 AM F1B Finding our Inner Jane Addams in Drug Policy Reform, Kassandra Frederique, MSSW; LaReese Harvey, BSW 9:00 AM - 9:40 AM F2A Participant-Directed Research: Using Art to Explore the Hopes and Dreams of Women Engaged in Prostitution, Corey Shdaimah,PhD, LLM; Shelly Wiechelt, PhD, LCSW-C, CCDC 9:50 AM - 10:30 AM F2B Gender Responsive Justice: Risk factors and Resilience in Women Convicted of Violent Crime, Judith Willison, PhD, LICSW; Marelin Vergara, MA 9:00 AM - 9:40 AM F3A Alternatives to Incarceration Mental Health Liaison - Diverting SPMI Clients Out of the Criminal Justice System into Community Mental Health Treatment, Lynn Unger, CSW 9:50 AM - 10:30 AM F3B Assisting Criminal Courts Supervise Persons with Mental Illness: A Recovery Model Approach, Daniel Ringhoff, MDiv, LCSW 9:00 AM - 9:40 AM F4A Harnessing the Power of Holistic Legal Services through Collaborative Outcome Measurement: A ClientCentered Approach, Joseph Mole, MSW, LSW; Emily Kirschbaum, MSW, LSW 9:50 AM - 10:30 AM F4B Short, Reliable and Population Tested: Support for using the brief version of the Buss-Perry Aggression Questionnaire with Assaultive Offenders, John Gallagher, MSW, Jose B Ashford, PhD, LCSW 9:00 AM - 9:40 AM F5A Refugee Children in Intensive Care- a Dynamic and Challenging Part of Medical Social Work at Astrid Lindgren Children’s Hospital in Stockholm, Sweden, Maria Linde 9:50 AM - 10:30 AM F5B Sexual Orientation Asylum Petitions: Challenges in Forensic Psychosocial Immigration Evaluations, Mark Silver, MA, MSW, LCSW, PsyD, JD 10:45 AM - Noon P1 Looking towards the Future of Forensic Social Work Education, Rob Butters, PhD and Stacey Hardy, PhD, JD, LCSW, Moderators; Jo Rees, Ph.D., Susan Robbins, Ph.D., LCSW, Robert Mulligan, MPS, LCSW 10:45 AM - Noon P2 Cultural Sensitivity within Child Welfare, Viola Vaughan-Eden, Moderator; Robert Ortega, LMSW, PhD; Frank E Vandervort, JD 10:45 AM - Noon P3 The Intersectionality of Current Juvenile Justice Issues: Youth Outcomes affected by Race/Ethnicity, Diagnoses, Disabilities, and/or Gender/Sexual Orientation, Susan McCarter, PhD, MS, MSW 10:45 AM - Noon P4 International and Interdisciplinary Perspectives on Vulnerable Care Populations: Towards a Human Rights Framework for Universal Health and Justice, Tina Maschii, PhD, LCSW, ACSW and Sarah Harvey, Public Health Social Worker, Perth Australia, Cordinators; Patricia Mackey (Australia); Mary, T. Harrison; Geraldine O’Hare, Chartered and Registered Forensic Psychologist; Christina Enders, Scientific Assistant at Catholic University of Applied Sciences Mainz, Germany; Roger Tan, Senior Medical Social Worker, Institute of Mental Health, Singapore. Noon - 2:00 PM Lunch on your own. 2:00 PM - 2:40 PM G2A Structural Violence and the School to Prison Pipeline: Experiences of LGBTQ Youth in Girls’ Juvenile Justice Facilities in New York State, SarahMountz, MSW, PhD 2:50 PM -3:30 PM G2B Coming Out: The Collaborative Development of a Program for LGBTQ People Involved With the Criminal Justice System, Jo Rees, PhD 2:00 PM - 2:40 PM G3A Improving Families and Motivating Court-Involved Fathers through Cognitive Behavioral Therapy, Jonathan Monsalve, MS; Bo Twiggs, LMSW 2:50 PM -3:30 PM G3B Collateral Consequences of Being on the Sex Offender Registry; Understanding the label Sex Offender and How to Effectively Advocate for these Client, Nicole Rochat, LMSW, CHHC; Heidi van Es, LMSW 2:00 PM - 3:30 PM G4 Trauma and Justice-Involved Women: The Change Program at York Correctional Institution, Lisa Ballint, LCSW; Elizabeth Allen, LCSW, PhD; Bill Chalsma, PsyD; Anna Duer, RN, APRN 2:00 PM - 3:30 PM G5 But It’s Not My Fault...: Moving Beyond Individual Treatment in Criminal Court Mandates, Elise White, PhD; Amanda Roaf, LMSW; Miriam Goodman, LMSW; Amanda Rivera, BA 3:45 PM -4:25 PM H1A For the Federal Defense: Beyond Mitigation, Towards Holistic Representation Social Work Practice at The Federal Defenders of NY, Eastern District, Vivianne Guevara, LMSW; Lisa Hoyes Esq. 4:40 - 5:15 PM H1B Gun Laws, Mental lllness, and Stigma after the Sandy Hook Elementary School Shooting: Implications for Social Work Practice and Policy, Jessica Rosenberg, PhD LCSW; Jo Rees, PhD 3:45 PM -4:25 PM H2A Cyber Bullying or Freedom of Speech? An Examination of Today’s School-Related First Amendment Issues through an LGBTQ Lens, Ariel Alvarez, PhD, JD; Svetlana Shpiegel, MSW, PhD 3:45 PM -4:25 PM H3A Clinical and Data Management Issues for the Older Offender on Parole, Keith Morgen, PhD, LPC, NCC, ACS; Abigail Voelkner 3:45 PM -5:15 PM H4 Advancing Cultural Competency Across Diverse Populations: Peeling Back the Layers, Viola Lindsey, PhD, MSW, ASW; Victoria Jackson, EdD, LCSW 3:45 PM -5:15 PM H5 How Mental Health Impacts the Formerly Incarcerated Population, Jessica Glass, LCSW; Marlon Peterson 3:45 PM -5:15 PM H6 Arguing on the Side of Culture, Robert Ortega, LMSW, PhD; Frank E Vandervort, JD; Debra Chopp, JD 5:30 - 6:30 PM Post Conference Workshop: The Use of the Arts for Individual and Social Transformation.and Justice, panel presentation with Tina Maschi, PhD, LCSW, ACSW; Ron Levine, MFA; Mary T. Harrison, BSW; Aileen Hongo, MSW, LPC; Anne Katz, PhD, MSW. 6:30 PM - 8:00 PM Mothers of Bedford Join us for a screening and discussion of this film exploring the effects of a long-term prison sentence on the relationship between a mother and child. Eighty percent of women in US prisons today are mothers of school-age children. Many a parent would find it difficult to be away from their child for a day, or even a week. But imagine being separated for ten to twenty years? Filmed over four years at the Bedford Hills Correctional Facility. Panel: Rebecca Sussman, Mona Graves and Dr. Mary Byrne. Conference Registration: Mail Conference Registrations to: National Organization of Forensic Social Work 460 Smith St, Ste K Middletown, CT 06457 Phone (860) 613-0254 Fax (866) 668-9858 Email: [email protected] Register online: http://nofsw.org/?page_id=14 Name: _____________________________________________Title: __________________ Organization: _______________________________________________________________ Address: ___________________________________________________________________ City: _____________________________________ State: ___________Zip: ____________ Phone: ______________________________________ Fax: _ _______________________ Email: _____________________________________________________________________ License Type: _____________ State: ______ License Number: _____________________ Special Considerations: If you have a disability or special dietary needs and/or require special services, please make this request in writing (by postal mail or email [email protected]) by July 18, 2014. Registration Fee: NOFSW Member: $375 Non-member: $475 Primary Conference Presenter: $187.50 for NOFSW Members, $237.50 for Non-members NOFSW Student Members: $150 Retired NOFSW Member: $225 Day Rate: (Circle one: Friday $100, Saturday $250 Sunday $250) $ _____ Total fee enclosed check or money order VISA MasterCard Card Number: ____________________________________________________________ Exp. Date: __________ Signature: _ ________________________________________________________________ Billing Address: _____________________________________________________________ City: _____________________________________ State: ___________Zip: ____________ A $25 fee will be assessed for refunds or cancellations before July 18, 2014. No refunds for cancellations received after July 18, 2014.