33nd Annual ConferenceThe 32nd annual conference will be held in Yankon, South Dakota on October 5-7, 2021 More details forthcoming. Register Now Agenda Forthcoming RegistrationConference registration is now open. Please click the button below to begin. Register For ConferenceRegister OnlineYou can now register online! Click the button below to get started. Register Online HereEmailE-mail completed registration form to: jgierisch@utah.gov Or mail the completed form to: Jana Gierisch, WPSHA Executive Director P.O. Box 270 Provo, Utah 84603-0270 Telephone: (801)344-4200 Facsimile: (801)344-4291 2021 Annual Conference Information and ProgramWhenBegins on October 5th, 2021.Yankton, SDMore Information Forthcoming2021 Conference Registration Member Name* First Last Title* Agency or Organization* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code Email* Enter Email Confirm Email Phone*Registration Fees: see description below* WPSHA (full membership) Dues Prepaid – one attendee per hospital (WPSHA affiliate states only – CEO or director who has responsibility for the planning and execution of a western state psychiatric hospital; eligible for reimbursement up to $1650 Additional attendee member hospitals 2nd membership prepaid for additional attendee (eligible for reimbursement up to $1150) Walk-up registration $250.00 (member hospitals) : (each additional attendance (member hospitals); not eligible for reimbursement of expenses) Non-WPSHA affiliated registration $450.00 (All non-WPSHA affiliated states; not eligible for reimbursement of expenses) Alumni Membership - $250.00 Additional AttendeesQuantity of additional attendees (100.00 each)NoneOne Additional + 1Two Additional + 2Three Additional + 3Four Additional + 4Name First Last Email Name 1 First Last Email 1 Name 2 First Last Email 2 Name 1 First Last Email 1 Name 2 First Last Email 2 Name 3 First Last Email 3 Name 1 First Last Email 1 Name 2 First Last Email 2 Name 3 First Last Email 3 Name 4 First Last Email 4 Campus TourCampus Tour of South Dakota Human Services Center on October 5 from 1:00 - 5:00 p.m.* Yes. I will be attend the campus tour of South Dakota Human Services Center No. I will not be attending the tour Banquet on Tuesday, October 5 at 6:00 p.m.* Yes. I will be attending the banquet. No. I will not be attending the banquet. Additional Guest Attending DinnerNonePlus one guest +1Plus two guests +2(spouse or significant other are welcome)Please list any dietary restrictions. Total $0.00 CommentsThis field is for validation purposes and should be left unchanged.
