FSOSW Conference Registration Form

First Name:
Last Name:
License Number:
Mailing Address:
City
State
 Zip:
Work Telephone
Home or Cell Telephone
Email Address:
Job Title:
Place of Employment
  This information is collected for networking purposes and will be used for your conference name badge.
Disability Accomidations Required
  Requests for accommodations received after Sept 15th may not be processed or fulfilled in time for the activity.
 
Mark your breakout selections here:
Pre-Conference Wednesday ICC Training
Breast Cancer Navigation Training
Thursday Session 1 (10:00AM-11:30AM) A - When Palliative Care and Oncology Interface
B - Building Resilience in Children and Adults
C - Cultural Competence Principles When Working with Women Who Partner with Women
Thursday Session 2 (1:30PM - 3:00PM)

A - Oncology Social Workers as Pioneers in Compassion Fatigue Responsiveness
B - Living with Survivorship: Medical, Psychosocial and Neurocognitive Issues for Young Adult Survivors of Childhood Cancer
Thursday Session 3 (3:30PM - 4:30PM) A - Sleep And Cancer: A Cognitive Behavioral Approach
B - Tomosynthesis: A New Era in Breast Imaging
C - Helping Your Patients Talk to their Children about Cancer
Friday Session 4 (8:30AM - 10:00AM) A - When Oncology Intesects Psychiatry
B - The Benefits of Complementary Therapies for Oncology Patients and Family Caregivers
C - The Impact of Stem Cell Transplant of Patients and Families
Friday Session 5 (10:15AM - 11:45AM) A - LGBTQI Healthcare Issues
B - Cancer in the Media
Friday Session 6 (12:00PM - 1:00PM) A - Working With Navigators to Support Patients Through Their Cancer Journey
B - Building your Oncology Social Work Program
C - Mindfulness Groups as a New Approach to Working with Advance Stage Cancer Patients
 

Early Registration
* Prior to Oct. 1, 2011
Regular Registration
* After Oct. 1, 2011
  
FSOSW Member
$150.00
$200.00
  
Students
$ 50.00
$ 75.00
  
Non-FSOSW members
$180.00
$230.00
 
 

Pre-Conference Cost
* Prior to Oct. 1, 2011
Regular Registration
* After Oct. 1, 2011
  
Member
$40.00
$50.00
  
Non-Member
$ 60.00
$ 70.00
NOTE: Registration is not complete until paypal transaction after pressing the Submit button is complete.
 
Cancellation and Refunds
Cancellation must be made no later than one week prior to the conference October 12, 2011 and must include a written request for a refund minus a $50.00 administration fee. The conference schedule is subject to change without notice. FSOSW is not responsible for losses experianced due to schedule changes, weather/travel restrictions, or loss/injury due to theft or negligence. Your registration implies agreement with these terms.
 
 
Thank you