REGISTRATION FOR MARCH 17 CONFERENCE & TRAINING ON MEDICATION-ASSISTED OPIOID TREATMENT
PLEASE COMPLETE THIS REGISTRATION TO RESERVE YOUR SLOT. WE WILL PROVIDE MATERIALS AND DIRECTIONS IN ADVANCE VIA EMAIL.

THE MORNING SESSION -- FROM 10:00 TO NOON -- WILL PROVIDE A GENERAL OVERVIEW OF MEDICATION-ASSISTED OPIOID TREATMENT, AND WILL BE OF INTEREST TO ALL HEALTH PROFESSIONALS SEEKING A WORKING KNOWLEDGE OF M.A.T.

THERE ARE TWO SIMULTANEOUS WORKSHOPS IN THE AFTERNOON:

ONE IS BUPRENORPHINE WAIVER TRAINING FOR PHYSICIANS, NURSE PRACTITIONERS, AND PHYSICIAN ASSISTANTS. (THIS WORKSHOP IS NOW FULL, BUT YOU MAY SIGN UP BELOW TO ADD YOUR NAME TO THE WAITING LIST IN CASE ADDITIONAL SEATS OPEN UP.)

THE OTHER IS A WORKSHOP ON PRACTICAL CHALLENGES IN PRESCRIBING BUPRENORPHINE IN A CLINICAL PRACTICE. THIS IS OPEN TO ALL PHYSICIANS AND OTHER PROFESSIONALS WHO CURRENTLY PRESCRIBE BUPRENORPHINE OR WHO ARE INTERESTED IN DOING SO. THERE IS NO SEATING LIMIT IN THIS WORKSHOP.

CO-SPONSORED BY:
FIRST NAME *
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LAST NAME *
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EMAIL ADDRESS *
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PROFESSION *
FIELD/SPECIALTY (IF ANY)
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WHERE DO YOU PRACTICE? *
WHAT VILLAGE OR CITY?
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AFFILIATIONS - HOSPITAL/HEALTHCARE NETWORKS
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AFFILIATIONS - PROFESSIONAL ASSOCIATIONS
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DO YOU PLAN TO ATTEND THE 4-HOUR BUPRENORPHINE WAIVER TRAINING BEGINNING AT 1:00? *
For MDs, this training satisfies the in-person requirements of the 8-hour training required for a DEA waiver. The remaining four hours can be done online. For NPs and PAs, a total of 24 hours of training are required. PLEASE NOTE: THIS SECTION IS NOW FULL AS OF 3-10-18. IF YOU INDICATE "YES" WE WILL PLACE YOU ON A WAITING LIST AND WILL NOTIFY YOU IF A SLOT OPENS. THE ALTERNATE SESSION IN THE AFTERNOON -- FOCUSED ON PRACTICAL CHALLENGES OF USING BUPRENORPHINE IN CLINICAL PRACTICE -- HAS SEATS AVAILABLE.
DO YOU HAVE EXPERIENCE TREATING OPIOID ADDICTION? *
If yes, please describe
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HAVE YOU RECEIVED A DEA WAIVER FOR PRESCRIBING BUPRENORPHINE? *
If yes, are you actively prescribing buprenorphine?
HOW DID YOU LEARN ABOUT THIS CONFERENCE?
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