Registration Information

Please note that although this is a two-day event, you may choose to attend only one day. Workshop registration fees include: a continental breakfast, lunch, and dinner on the 2nd, and/or a full breakfast and lunch on the 3rd. Please select the day(s) you plan to attend.

• Refund policy: A written request for a refund must be made by March 12, 2012.
• Conference confirmation: MeCA will confirm receipt of your registration by email ONLY. Please be sure to provide an accurate and legible email address on the form below as this will be the only means of confirmation. If you do not receive an email confirmation, that may indicate a problem with your registration. Contact Jeannie McKenney, jeannie.mckenney@mma.edu.
• Housing information: The Samoset Resort has offered a special rate for workshop participants of $117 per night/per room . Make your reservation by filling out and mailing or faxing the hotel reservation form directly to the Samoset Resort by March 1, 2012.
• Meals: Buffet meals with vegetarian options will be available.

Conference registration includes MeCA membership for ONE year (July 1 to June 30)

Please check the required fields

1. Full Name *
2. Address *
3. Address2  
4. City *
5. State *
6. Zip *
7. Work Phone *
8. Home Phone  
9. Email *
10. Employment  
11. Employment Address  
    Employment Address (if different from mailing address)
12. Employment City  
13. Employment State  
14. Employment Zip  
15. Educational Degree  (If currently a student)
16. Major  
17. Number of Years in Professional Field  
18. Occupation  
    Career Counselor (CAR) College Admissions Counselor (ADM) College Counselor (PSC) Counselor Educator (CED) Emeritus Member (EMS) Employment Counselor (EMP) Marriage and Family Therapist (MFT) Mental Health Counselor (MHC) Pastoral Counselor (PAS) School Counselor (SC) - K-5 School Counselor (SC) - 6-8 School Counselor (SC) - 9-12 School Counselor (SC) - K-9 School Counselor (SC) - K-12 Student (STD) Substance Abuse Counselor (SAC) Vocational Counselor (VOC) Other (OTH) Please specify:
    
19. Membership Type  
    Regular Membership Student Membership Emeritus Membership

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Divisional Membership:
20. Maine Career Development $10  
21. Maine Association for Specialists in Group Work $15  

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Regional Council Membership
22. Central Maine Counseling $5  
23. Downeast Maine Counseling $5  
24. Eastern Maine Counseling $10  
25. Northern Maine Counseling $10  
26. Southern Maine Counseling $10  
27. Conference Package (Early Bird registrations NEED to be postmarked or received by 12/1/11)  
    Full Conference (2 days) Professional - $275 Full Conference (2 days) Student - $150 One Day Only - Professional - $200 One Day Only - Student - $120
28. Security Code: *
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Cost:
29.