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PERSONAL INFORMATION: This information will appear on your name badge exactly as you provide it. Please print legibly or type. Name: ____________________________________________________________________________________________________________ Institution: _____________________________________________________________________________________________________________________________________ Address: _______________________________________________________________________________________________________________________________________ City, State, Zip: ________________________________________________________________________________________________________________________________ Phone: ________________________________________________________________ Fax: __________________________________________________________________ E-mail: ________________________________________________________________________________________________________________________________________ GENERAL REGISTRATION FEE: Please select the appropriate option below. After October 12, you must register online. Postmarked by September 21 After September 21 Onsite or Online NAN Member or Applicant (Fellow, Professional, Associate, Affiliate) $475 $525 NAN Post-Doctoral Member or Applicant (enclose verification of status) $275 $315 NAN Student Member or Applicant (enclose verification of status) $150 $180 Non-Member $625 $675 Non-Member Student (enclose verification of status) $200 $230 5. Student Luncheon (STUDENTS & POST-DOCS ONLY) $15 $25 Women in Leadership Networking Event Student $35 NAN Member $60 Non-Member $80 Guests Attending Continental Breakfast & Reception Adult $75 Child $25 Guest Names: _________________________________________________________ WEDNESDAY, OCTOBER 17 CE Workshop (2 CE) 7:00 am - 9:00 am 1. Stringer - ABCN Test Prep CE Workshops (3 CE) 9:00 am - 12:00 pm 2. Chaytor & Robertson - Ecological & Naturalistic Assessment 3. Kraft, et al. - Emerging Practices in Neuropsychology 4. Settles - Childhood Brain Development Trajectories CE Workshops (2 CE) 1:00 pm - 3:00 pm 6. Iverson - Concussion Recovery & Sequelae 7. Cohen - Neuropsychology: Integrating Biobehavorial Measurement 8. Schoenberg - Adult Grand Rounds Welcome & NAN Business Meeting 3:30 pm - 4:30 pm CE Workshop (1 CE) 4:30 pm - 5:30 pm 9. Puente - CPT Update Keynote Address (1 CE) 5:30 pm - 6:30 pm 10. Ratey - Exercise & the Brain Please note: While there is no charge for these programs, we do require those wishing to attend to register, due to room capacities & fire code regulations. To receive CE credit, you must be scanned in and out of a course and have attended at least 75% of the session. You cannot register in advance for more than one course in competing timeslots. October 17 - 20, 2018 | Sheraton New Orleans | New Orleans, Louisiana NAN 2018 Annual Conference Are you a licensed pysychologist? (APA requires this information) Yes No Are you a first time attendee? Yes No Do you have any dietary restrictions or do you require any special services? Yes No Please tell us your dietary restrictions or services you requre: ___________________________________________________________________ I agree to allow NAN to provide my contact information to companies exhibiting at the Annual Conference for promotional marketing via mail. NAN does not sell or provide email addresses. Yes No