2014 fall conference flyer 7 - north carolina psychological association€¦ · ·...

North Carolina Psychological Foundation North Carolina Psychological Association

2014 NCPF/NCPA FALL CE INSTITUTES

FRIDAY, SEPTEMBER 19 & SATURDAY, SEPTEMBER 20, 2014 THE FRIDAY CENTER - CHAPEL HILL, NC

FRIDAY, SEPTEMBER 19 Competency/Cognitive Assessment of Older Persons

Ann Louise Barrick, Ph.D. Bryan E. Connell, Ph.D.

Eric B. Elbogen, Ph.D., ABPP

Working with Immigrant Populations: Clinical and Ethical Considerations* Gabriela Livas Stein, Ph.D.

SATURDAY, SEPTEMBER 20

Healing Microaggressions and Other Insensitivities That Occur in Group Therapy Nina W. Brown, Ed.D.

The Psychologist in Court: Legal, Practical and Ethical Considerations*

Jane E. Perrin, Ph.D. Marilyn Feuchs-Marker, J.D.

Walt Jones, J.D. R. Mark Lewis, Ph.D.

Martha C. Massie, J.D. John Neiman, J.D.

*AN ASTERISK (*) INDICATES THIS INSTITUTE IS INTENDED TO MEET THE ETHICAL/LEGAL CE REQUIREMENTS

FOR NC PSYCHOLOGISTS

The North Carolina Psychological Association is approved by the American Psychological Association to offer Category A Continuing Education credit for psychologists.

2014 NCPA/NCPF Fall CE Conference

Friday, September 19 – Institute No. 1

Competency/Cognitive Assessment of Older Persons Ann Louise Barrick, Ph.D., Clinical Professor of Psychology, UNC-Chapel Hill (Retired)

Bryan E. Connell, Ph.D., Connell Psychological Services, Charlotte

Eric B. Elbogen, Ph.D., ABPP (Forensic Psychologist) Demographics indicate that greater numbers are reaching the era of post-retirement than ever before (1). Aging steadily increases the risk for the progressive dementias (2), of which Alzheimer’s disease accounts for the lion’s share (3). Against this background, clinical psychologists are facing the referral of patients and/or caretakers who need science-based answers to a myriad of practical questions that accompany this scenario.

Examples of such pertinent questions include: 1) Does my loved one or I suffer from cognitive decline that is greater than what might be expected by age alone? 2) Does my loved one or I necessarily require a comprehensive neuropsychological evaluation to answer practical questions about basic cognitive functioning? 3) Can my loved one or I continue to carry out normal activities of daily living sufficiently to live independently? 4) Can it be determined whether my loved one or I continue(s) to maintain sufficient cognitive functioning to make important decisions about medical care, manage finances, or make out/make changes to a will? 5) My loved one or I, or both, has/have a chronic psychiatric history. Is cognitive decline expected over time from this condition, or does cognitive decline necessarily represent a separate condition of dementia? This program is designed as a basic introduction for clinicians to the realm of cognitive decline and functional behavior in the aging population. This will include discussions of normal and abnormal aging, and medical conditions associated with declines in cognition and functional behavior. The program will introduce methods of gathering relevant information including medical/psychiatric history, clinical interview, a screening tool (MOCA 4) and 2 formal assessment tools (RBANS 5 and ILS 6). The program will include instruction and practice time in administration of these tests. In addition, we will review assessing specific capacities including financial, treatment decision-making, and writing a will and give an overview of models for conducting these types of evaluations (7, 8, and 9). Finally, this program will offer discussion of case studies utilizing these assessment methods.

1. Centers for Disease Control and Prevention and The Merck Company Foundation. The State of Aging and Health in America, 2007. Whitehouse Station, NJ: The Merck Company Foundation; 2007.

2. Plassman, BL; Langa, KM; Fisher, GG; Heeringa, SG; Weir, DR; et al. “Prevalence of dementia in the United States:” The Aging, Demographics, and Memory Study.” Neuroepidemiology 2007; 29 (1-2); 125-132.

3. Hebert, LE; Scherr, PA; Bienias, JL; Bennett, DA; Evans, DA. ”Alzheimer’s disease in the U.S. population: Prevalence estimates using the 2000 Census.” Archives of Neurology 2003; 60 (8); 1119-1122

4. Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment. Journal of the American Geriatrics Society. 2005;53(4):695-699.

5. Repeatable Battery for the Assessment of Neuropsychological Status. Christopher Randolph. PsychCorp. 1998, 2012 NCS Pearson, Inc. Bloomington, NC 55437

6. Independent Living Scales. Patriia Anderten Loeb. Psychcorp. 1996 NCS Pearson, Inc. San Antonio, TX 78259. 7. Marson DC, Sawrie SM, Snyder S, et al. Assessing financial capacity in patients with Alzheimer disease. Archives of

Neurology. 2000;57:877-884. 8. Appelbaum PS, Grisso T. The MacArthur Treatment Competence Study: I. Mental illness and competence to consent to

treatment. Law and Human Behavior. 04 1995;19(2):105-126. 9. Marson DC, Hebert K, Larrabee GJ. Assessing Civil Competencies in Older Adults With Dementia: Consent Capacity,

Financial Capacity, and Testamentary Capacity. Forensic neuropsychology: A scientific approach. New York, NY US: Oxford University Press; 2005:334-377.


By the end of the Institute participants will: 1. be able to state 3 cognitive changes associated with aging; 2. be able to state 3 routine issues related to capacity and cognitive assessment in older persons; 3. be able to name 5 typical medical conditions that can adversely affect cognitive functioning in older persons; 4. have learned relevant interview questions for assessing cognitive functioning in older persons; 5. be able to name 2 useful cognitive assessment tools for use with the elderly; 6. have learned to correctly administer and interpret the results of one cognitive assessment tool; 7. be able to identify routine collateral sources to use when assessing older persons as well as issues that may affect the usefulness of the information obtained from these sources; 8. be able to make relevant clinical decisions based on formal assessment results and collateral sources; and 9. be able to distinguish between symptoms related to major mental illness and dementia.

INSTRUCTIONAL LEVEL: Basic EDUCATIONAL FORMAT: Lecture, discussion, case reviews, skill training

INSTITUTE INFORMATION Time: 9:00 am - 12:15 pm; 1:30 - 4:45 pm

Credit: 6 hours Category ‘A’ Continuing Education Credit

Attendance: To receive credit, you must be present for the entire institute, and you must sign the sign-in and sign-out sheets.

No partial credit can be given. No credit will be given to participants who are more than 15 minutes late at the beginning of the institute. No credit will be given to participants who leave before the close of the institute.

Fee: $175 - NCPA Members & Other Professionals $140 - Early Career Psychologists (must be an NCPA Member) $240 - Psychologists Not Members of NCPA $70 - Students/Interns (includes lunch and breaks; 10 slots available)

Note: An additional $40 fee will be charged for any registrations received after NOON on Thursday, September 11, 2014.

Ann Louise Barrick, Ph.D. is a retired Clinical Professor of Psychology at the University of North Carolina-Chapel Hill, Department of Psychology and was the Director of Psychology at Central Regional Hospital, Butner, NC. She holds a doctoral degree in Counseling Psychology from Ball State University and has been a geropsychologist since 1986. She provides training to professional staff in the assessment and treatment of persons with dementia. She has conducted research and published articles addressing behavioral symptoms in dementia and is coauthor of a book, CD-ROM/DVD, and two training films on methods for bathing and a training DVD on providing oral care for persons with dementia.


Bryan E. Connell, Ph.D. is the sole proprietor of Connell Psychological Services in Charlotte, N.C. His practice focuses on services for patients and caregivers coping with the stress of dementia and chronic medical illness, using techniques garnered from 2 decades of clinical practice in clinical health and neuropsychology. The practice is mobile, serving clients at the place of residence, be it long-term care facility or family home, to reduce the burden of patient transportation. Areas of interest include coping with neurological conditions (e.g., Alzheimer’s disease, epilepsy, stroke, multiple sclerosis, brain injury, brain tumor, Parkinson’s disease), sleep disorders, breathing disorders, diabetes, and general health/wellness management. In terms of training, Dr. Connell received his PhD in Clinical Medical Psychology from the University of Alabama @ Birmingham. He interned at the University of Florida/Shands Hospital, and completed a Post-Doctoral Fellowship in Neuropsychology at the Health Science Center, University of Tennessee @ Memphis. Dr. Connell has been licensed to practice psychology in North Carolina since 1992. He is a designated North Carolina Health Services Provider Psychologist (HSP-P).

Eric Elbogen, Ph.D. is a forensic psychologist who conducts both clinical work and empirical research at the intersection of law and mental health services, with a particular focus on military veterans. Dr. Elbogen is currently Principal Investigator of an NIMH funded R01 examining the effects of Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) on violence and aggression among Iraq/Afghanistan Veterans. He is Principal Investigator (PI) of a U.S. Department of Education funded project investigating improving financial capacity among veterans with psychiatric disabilities. He is also PI of a U.S. Department of Defense funded randomized clinical trial of a cognitive rehabilitation intervention to improve executive function in Veterans with PTSD and TBI. In terms of clinical work, Dr. Elbogen currently provides forensic and neuropsychological

assessments at Central Regional Hospital in Butner, N.C., in addition to forensic, neuropsychological, and personality testing through the UNC Forensic Psychiatry Program and Clinic.


Friday, September 19 – Institute No. 2

Working with Immigrant Populations: Clinical and Ethical Considerations* Gabriela Livas Stein, Ph.D.

Assistant Professor of Psychology, UNC-Greensboro

*THIS INSTITUTE IS INTENDED TO MEET THE ETHICAL/LEGAL CE REQUIREMENTS FOR NC PSYCHOLOGISTS

This institute will focus on clinical considerations in working ethically with immigrant populations. The institute will provide information about the immigrant groups most prevalent in North Carolina (Latinos, East Asians, South Asians) as well as therapeutic considerations for these groups. The workshop will also address conducting assessments (e.g., IQ, LD, citizenship evaluations). Other topics will include the use of translators, providing supervision, and ethical practice. By the end of the Institute participants will: 1. learn about the immigrant and historical issues with immigrant groups, and will be able to list 5 major stressors for immigrant populations that affect psychological functioning; 2. be able to list 5 cultural considerations for Latino clients and how they impact ethical clinical intervention; 3. be able to list 5 cultural considerations for Asian clients and how they impact ethical clinical intervention; 4. be able to list 4 principal considerations when conducting assessments with immigrant groups; 5. be able to list 3 appropriate assessment instruments when working with non-English speaking clients and groups; 6. be able to list 3 ethical considerations in working with immigrant groups, based on a case presentation material; and 7. be able to list 3 strategies to working with interpreters. INSTRUCTIONAL LEVEL: Basic

EDUCATIONAL FORMAT: Lecture, discussion, clinical vignettes

INSTITUTE INFORMATION Time: 9:00 am - 12:15 pm; 1:30 - 4:45 pm




Fee: $175 - NCPA Members & Other Professionals $140 - Early Career Psychologists (must be an NCPA Member) $240 - Non-NCPA Member Psychologists $70 - Students/Interns (includes lunch and breaks; 10 slots available)



Dr. Gabriela Livas Stein is an assistant professor in psychology at the University of North Carolina at Greensboro. She graduated from Columbia University in 1999, and received her Ph.D. in child clinical psychology from UNC-Chapel Hill in 2007. She was awarded the 2007 APA/APAGS Award for Distinguished Graduate Student in Professional Psychology for her work with Latino populations. In 2012, she was awarded the Latino Diamante Award in Education for making

a significant contributionto the Latino community in North Carolina. Her research focuses on the interplay between culture and risk factors in predicting psychopathology in ethnic minority youth. In particular, her work examines the specific links between experiences of discrimination and depressive symptoms in Latino youth, as well as the role of familial cultural values in providing protection against these symptoms.

One of the missions of NCPF is to establish meaningful connections with and help serve the psychology graduate student and intern population. An impactful way of demonstrating this commitment is by sponsoring a psychology student or intern; we encourage you to consider giving someone an opportunity to attend the 2014 Fall CE Institutes who would otherwise not be able to attend via sponsorship. Sponsors have two options:

� Cover the registration cost of a student or intern to attend ONE day at the Conference

(Friday or Saturday) for $70: OR

� Cover the registration cost of a student or intern to attend BOTH days for $130.

The cost of a sponsorship includes lunch and refreshments. If you would like to be a sponsor, or are a student or intern looking to be matched with a sponsor, please mark the appropriate space

on the registration form.

We are incredibly thankful for the generosity of our sponsors; without your support, many students and interns simply would not be able to attend this conference.

THANK YOU!!!

Please Note: You do NOT need to attend the conference in order to be a sponsor.


Saturday, September 20 – Institute No. 1

Healing Microaggressions and Other Insensitivities That Occur in Group Therapy Nina W. Brown, Ed.D.

Professor and Eminent Scholar, Old Dominion University

Group therapy provides a setting that is especially vulnerable for disruptions to the group progress, and ruptures to relationships among group members and with the leader because of microaggressions and other insensitivities that can lead to narcissistic injuries. The varying backgrounds, personalities, past narcissistic injuries and experiences of group members and the leader can all contribute to insensitivities and microaggressions emerging in the group. The Institute will explore the impact of these and of the receiver’s alternatives for responding on individual group members, the group as a whole, and on the leader. Strategies for increasing group leaders’ awareness, identifying members’ vulnerabilities to these acts, and intervention techniques will be presented. By the end of the Institute participants will: 1. list and describe the categories for microaggressions; 2. identify personal characteristics that can produce vulnerability to receiving microaggressions; 3. develop an increased awareness of the impact of microaggressions and other insensitivities on the group and on its members; 4. describe possible leader intervention strategies; 5. define narcissistic injury and understand how it can impact the individual; and 6. understand a process to guide self-healing from narcissistic injuries. INSTRUCTIONAL LEVEL: Intermediate EDUCATIONAL FORMAT: Lecture, discussion, small group discussions, YouTube vignettes INSTITUTE INFORMATION Time: 9:00 am - 12:15 pm; 1:30 - 4:45 pm




Fee: $175 - NCPA Members & Other Professionals $140 - Early Career Psychologists (must be an NCPA Member) $240 - Non-NCPA Member Psychologists $70 - Students/Interns (includes lunch and breaks; 10 slots available)



Nina W. Brown is a professor and eminent scholar of counseling at Old Dominion University in Norfolk, VA, a Fellow of the American Group Psychotherapy Association (AGPA) and a past president of The Society for Group Psychology and Group Psychotherapy (APA Division 49). She received her doctorate from The College of William and Mary, and has completed additional group training from AGPA and its affiliate, MAGPS. Dr. Brown is the author of over 26 books on the topics of group therapy and narcissism, several of which have been translated into foreign languages.

Saturday, September 20 – Institute No. 2

The Psychologist in Court: Legal, Practical and Ethical Considerations* Jane E. Perrin, Ph.D.

Marilyn Feuchs-Marker, J.D. Walt Jones, J.D.

R. Mark Lewis, Ph.D. Martha C. Massie, J.D.

John Neiman, J.D.

*THIS INSTITUTE IS INTENDED TO MEET THE ETHICAL/LEGAL CE REQUIREMENTS FOR NC PSYCHOLOGISTS

Psychologists are often asked to testify in court on a myriad of matters. Although psychologists may feel anxious about their participation in forensic settings, their testimony can be invaluable in assisting the court in determining the resolution of legal issues. Unfortunately, psychologists are often ill prepared for the adversarial environment of the legal system. This Institute will provide psychologists with information and skills for testifying in legal settings. The presentations will focus on practical, ethical and substantive legal aspects of psychologists’ roles as witnesses, beginning with the psychologist’s initial contact with the court through testifying at trial. Two family lawyers, a public defender, a prosecutor and two psychologists will share their knowledge and insights. The format will be didactic, role-playing of vignettes and question and answer opportunities for the audience. By the end of the Institute participants will: 1. define legal terms that are pertinent to psychologists’ court involvement; 2. prepare emotionally and practically to participate as an effective witness in a legal proceeding; 3. identify the APA Forensic Guidelines (2012) and ethical issues that commonly arise for psychologists in forensic settings; 4. respond to a subpoena; 5. effectively engage in depositions; 6. effectively engage in direct examinations and cross examinations in the courtroom; and 7. avoid common mistakes made by psychologists who are engaged in the legal system as fact or expert witnesses. INSTRUCTIONAL LEVEL: Basic - Intermediate EDUCATIONAL FORMAT: Lecture, discussion, role-playing vignettes

2014 NCPA/NCPF Fall CE Conference INSTITUTE INFORMATION Time: 9:00 am - 12:15 pm; 1:30 - 4:45 pm

Credit: 6 hours Category A Continuing Education Credit


No partial credit can be given. No credit will be given to participants who are more than 15 minutes late at the beginning of the institute. No credit will be given to participants who leave before the close of the Institute.

Fee: $175 - NCPA Members & Other Professionals $140 - Early Career Psychologists (must be an NCPA Member) $240 - Psychologists, non-NCPA Members $70 - Students/Interns (includes lunch and breaks; 10 slots available)


Jane E. Perrin, Ph.D., has practiced psychology in Greensboro since 1985. She and Mark Lewis, Ph.D are partners in Child Custody Center, LLP, which conducts consultations and court-ordered child custody evaluations. She also practices psychotherapy at LeBauer Behavioral Health. She earned her MA and Ph.D. in Psychology (Developmental) from UNC-CH in 1980, and she completed Clinical retraining from UNCG in 1985. Jane has served as a material and an expert witness in various types of cases, including medical malpractice, criminal and family law. Jane is a past president of NCPA. She has served on the North Carolina Psychology Board for the past eight years and was its chair for four years. Her presentation will reflect her own and not the Psychology Board’s opinions.

Marilyn Feuchs-Marker, J.D. has practiced law at Smith Moore Leatherwood (formerly Smith Helm Mulliss and Moore) in Greensboro since 1990. She specializes in the practice of family law, including custody and child support, spousal support, division of assets and pre- and post- marital agreements. Marilyn earned her Juris Doctor degree from Loyola Law School and has an MSW from the University of Maryland in Baltimore. She has been listed as one of the best lawyers in America (Woodward/White, Inc.), Family Law (2006-2014).

Walter Jones is a 1986 graduate of North Carolina State University, and a 1989 Graduate of Campbell University School of Law. From 1989-1991 he served as a law clerk for United States Magistrate Judge P. Trevor Sharpe. Following that, he was the assistant public defender in the Guilford Public Defenders office beginning in 1991 until 1996. From 1996 to 2005 he became a Partner at Clifford Clendenin Ohale and Jones; then from 2005-2007 he was partner at Jones Free and Knight. Since 2007 he has been the Chief assistant DA in the High Point Office of Guilford County District Attorney’s Office.


R. Mark Lewis, Ph.D., has practiced psychology in Greensboro since 1993. He divides his time between Child Custody Center, LLP, which he opened in 1995 and is now a partner with Jane Perrin, Ph.D.; and Developmental and Psychological Center, where he conducts evaluations and treatment of children. Mark has 24 years of experience as an expert witness, both in child custody cases in California and North Carolina, and as an independent psychological examiner, primarily in medical malpractice cases, across the country. He earned his MA and Ph.D. in psychology (clinical) from Alliant University (CSPP: San Diego, CA). He also

earned an MA in counseling psychology from Colgate University. Martha Massie, J.D., is a Greensboro family law attorney who has practiced law since 2003, first at Wyatt Early Harris and Wheeler, LLP, and since 2006 at Massie Law Office. She handles cases involving termination of parental rights, child custody, child support, alimony, equitable distribution, domestic violence and divorce. Martha practices collaborative as well as adversarial law. She earned her law degree from UNC-CH after earning an MA in Mass Communications and following careers in restaurant management, television news and automobile sales.

John Nieman is a 1981 graduate of UNC-G and a 1992 graduate of NCCU Law School. From 1992-1994 he was a Partner at Kinnaird and Nieman, and from 1994-2000 he served as Assistant District Attorney in Guilford County before becoming Head of Criminal Defense Division of Donaldson and Black from 2000-2004. Since 2004 he has served as Assistant Public Defender Guilford County, Chief Assistant, High Point Office.

REMINDER - CONTINUING EDUCATION REQUIREMENTS FOR PSYCHOLOGISTS IN NC:

Psychologists in NC must have at least 18 hours of Continuing Education Credit. These 18 hours must include: Category ‘A’ – 9 hours* (Minimum) Category ‘B’ – 9 hours (Maximum)

*At least 3 out of the 9 Category ‘A’ CE hours MUST meet the Ethical/Legal Issues requirement. All 18 hours must be completed by September 30, 2014.

For more information on CE requirements visit the NC Psychology Board’s website at www.ncpsychologyboard.org or call 828.262.2258.


INFORMATION

Conference Registration Fee, Deadlines, and Refund Policy: The registration fee includes the institute (s) selected, refreshment breaks, and lunch each day. Each registration fee includes $5 that will be placed in a fund to provide accommodations for persons needing assistance, such as interpreters. The deadline for registration is Thursday, September 11, 2014 at 12pm NOON. A $40 late fee is added for registration received after noon on September 11, 2014. You will receive a full refund for cancellation before Friday, September 5, 2014, a one-half refund by noon on Thursday, September 11, 2014 and no refund after noon on Thursday, September 11, 2014.

A $40 administrative fee will be deducted from all refunds.

Continuing Education Credit: The North Carolina Psychological Association is approved by the American Psychological Association to sponsor continuing education for psychologists. The North Carolina Psychological Association maintains responsibility for this program and its content. Each session is offered for 6 hours of continuing education credit. The credits are Category “A” under the rules of the North Carolina Psychology Board. Attendance Requirements: To receive credit, you must be present for the entire institute, and you must sign the sign-in and sign-out sheets. No credit will be given to participants who are more than 15 minutes late at the beginning of the morning and afternoon session. No credit will be given to participants who leave before the close of the institute. Ethics & Legal: If an institute is intended to meet the NC Psychology Board Requirements, it will be noted directly under the title of the workshop or institute. Facility Information: The Friday Center is located just off I-40 in Chapel Hill. Use the Highway #54 exit (273 A or B). Directions will be mailed to you with your registration confirmation & posted on www.ncpsychology.org. Hotel Information: NCPA has reserved a block of rooms at the Courtyard by Marriot (919.883.0700 or 800.321.2211) next to the Friday Center. If you call in please let them know for room block Fall CE Conference. Simply click on or copy & paste the following link into your browser to make an online reservation for a room: www.marriott.com/RDUCH. The reservation deadline is September 4, 2014, so please reserve your room early. Other hotels near the Friday Center are also posted on the NCPA website. Special Needs: If you have special dietary needs (vegetarian, a medical issue, etc.) or physical requirements note this on the registration form. This information must be received by 9.11.14. Student Sponsor: Please consider sponsoring a graduate student or psychology intern to attend the conference (limit = 10 slots per offering). See the information on p.6.

Exhibitors: NCPF/NCPA is fortunate to have a number of exhibitors who support the conference. Please help us show our appreciation by visiting the exhibit area during breaks and meal hours. Thank You! No Smoking: All institutes are non-smoking. Program/Continuing Education Committee: Catherine Forneris, Ph.D., Chair; Suzanne Bates, Ph.D., Michael Bigsby Ph.D., Jerry Brittain, Ph.D., Barton Evans, III, Ph.D., Mary Ann Garcia, Ph.D., Andrew Goff, Ph.D., Lisa Hayutin, Ph.D., Susan Hurt, Ph.D., Abra Carroll Nardo, Ph.D., Janet Savia, Psy.D., Kacey Jo Wilson, Ph.D., Sally Cameron and Carol Kulwicki.

For Additional Information Contact: NC Psychological Foundation, 1004 Dresser Court, Suite 106, Raleigh, NC 27609

Phone: 919.872.1005 Fax: 919.872.0805 Email: [email protected] Web: www.ncpsychology.org

2014 NCPA/NCPF FALL CONFERENCE: SEPTEMBER 19 & 20 - REGISTRATION FORM REGISTRATION DEADLINE: SEPTEMBER 11, 2014 at NOON

Name_______________________________________________________________________Degree_____________ First Name Last Name

Address_____________________________________City________________________State _____ Zip___________

Phone Number ___________________________ Email __________________________________________________ REQUIRED FOR CE EVALUATION LINK

Profession (Psychologist, Social Worker, etc.) __________________________________________________________

Select ONE Institute Per Day: Friday, September 19, 2014 ___ Competency/Cognitive Assessment of Older Adults OR

___ Working with Immigrant Populations: Clinical and Ethical Considerations

Saturday, September 20, 2014 ___ Healing Microaggressions and Other Insensitivities That Occur in Group Therapy OR

___ The Psychologist in Court: Legal, Practical & Ethical Considerations

NCPA Members* Early Career Psychologists Psychologist Non- & Other Professions (Must be NCPA Member) NCPA Members Students 1 day - Fri or Sat $175 _____ $140 _____ $240 ____ $70 ____ *2 days - Fri & Sat $320 _____ $250 _____ $450 ____ $130 ____ AFTER 12pm on 9.11.14 ADD: $40 _____ $40 _____ $40 ____ $40 ____

TOTAL PAID $_____________

*NOTE: A $30 discount has been allowed for attending both a Friday and Saturday Institute ($10 for students)* Graduate Student /Intern Sponsor -1 day: $70 _____ Graduate Student/Intern Sponsor - 2 days: $130 _____ ___ I will be a Friday and/or Saturday Student Sponsor (pay $70 or $130 on Student Sponsor line). ___ I am a Graduate Student/Intern and would like a Sponsor; fill in name, etc. above and return form). ___ Special Needs I have special needs (dietary/physical): ___________________________________________ (Must be notified by 9.11.14)

PAYMENT METHOD Circle One: Check MasterCard Visa For credit card payment, please complete the following: Name (as it appears on card) _____________________________________________________________________

Card Number ________________________________________________ Exp. Date________ CVV #____________ 3-digit # on back of card

Exact Billing Address of Card_______________________________________________________________________

City ________________________________________________________ State _______Zip____________________

Signature ______________________________________________________________________________________ PLEASE SEND REGISTRATION FORM with either a check payable to NCPF or credit card information to:

NCPF, 1004 Dresser Court, Suite 106, Raleigh, NC, 27609 OR fax form to 919.872.0805. Email questions to [email protected].

Note: Registration is not considered received unless it is accompanied by payment; spaces will NOT be reserved without payment.

2014 fall conference flyer 7 - north carolina psychological association€¦ · ·...

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