NJPN Annual Addiction Conference 2023: ENGAGE + EMPOWER

Registration Form

Attendee registration form

NJPN 2023 Annual Conference Registration Form

Thank you for your interest in joining the NJPN 2023 Annual Addiction Conference: ENGAGE + EMPOWER Two-Day LIVE Virtual Event on May 18 & 19, 2023. Registration for the conference is at no cost for all registrants thanks to funding from the NJ Division of Mental Health and Addiction Services (NJDMHAS) and the NJ Department of Health (NJDOH).

Please complete the registration form below and once your registration has been accepted, a confirmation email will be sent to the email address you provide. Thank you, and we look forward to greeting you on May 18th!

First Name (as it should appear on your Certificate)

Last Name (as it should appear on your Certificate)

Organization/Agency

I am not currently employed (This will not affect registration)

City

State

ZIP code

County

Job Title

Email Address (for log in)

Repeat Email Address (for log in)

Password

Primary Phone Number

Would you like to receive text notifications regarding the live event ?

Enter Number

Pronouns, as it should appear next to your name for networking

Gender

Age

Which race/ethnicity best describes you?

Which area of the addiction field are you most involved/interested in?

Please select the category that best describes your work

Please select all credential/s you currently hold

Select all

How many times have you previously attended the NJPN Annual Addiction Conference?