2012 Conference Registration

Registration Form

Name (as you would like it to appear on your nametag including credentials):

Org/School (if applicable):

Address:

City:

State:
Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip code:

Work phone:

Home phone:

Fax:

E-mail:

Please list any dietary restrictions:

Would you be interested in attending a luncheon for parents/families on Friday:
Yes     No

Friday Workshops

For each session, please mark your first and second preference accordingly.

General: Medical Complications of Anorexia Nervosa and Bulimia and their Treatment

Session I

First choice:
Please select... DBT with a Twist Eating Disorders, Celiac Disease, and Food Sensitivities Bone Health in Adolescents with Eating Disorders

Second choice:
Please select... DBT with a Twist Eating Disorders, Celiac Disease, and Food Sensitivities Bone Health in Adolescents with Eating Disorders

Session II

First choice:
Please select... The Challenge of Treating Patients with Chronic Eating Disorders From Silence to Freedom; Effective Treatment of Sexual Trauma and Eating Disorders Using Metaphor to Access and Treat Eating Disorders

Second choice:
Please select... The Challenge of Treating Patients with Chronic Eating Disorders From Silence to Freedom; Effective Treatment of Sexual Trauma and Eating Disorders Using Metaphor to Access and Treat Eating Disorders

Session III

First choice:
Please select... Internal Family Systems Therapy: A Safer and Easier Way to Work With Eating Disorders and Addictions Motivational Interviewing for Clinicians The Self-Compassion Diet: Treating Binge Eaters with Loving-Kindness Connectivity: Effectively Utilizing Social Media and Technology in Eating Disorders Recovery

Second choice:
Please select... Internal Family Systems Therapy: A Safer and Easier Way to Work With Eating Disorders and Addictions Motivational Interviewing for Clinicians The Self-Compassion Diet: Treating Binge Eaters with Loving-Kindness Connectivity: Effectively Utilizing Social Media and Technology in Eating Disorders Recovery

Session IV

First choice:
Please select... A Collaborative Recovery Model: Narrowing the Divide between Treatment, Support, and Community Understanding Binge Eating Disorder and the 12-Step Model of Recovery Yoga tools for ED therapy

Second choice:
Please select... A Collaborative Recovery Model: Narrowing the Divide between Treatment, Support, and Community Understanding Binge Eating Disorder and the 12-Step Model of Recovery Yoga tools for ED therapy

Saturday Workshops

For each session, please mark your first and second preference accordingly.

Keynote: Doug Bunnell, PhD

Session V

First choice:
Please select... Transforming Binge Eating with Innovative Body/Mind Modalities Eating Disorders and PCOS: Exploring causes, effects, and treatments for those who struggle Treating Eating Disorders with Acceptance and Values Based Approaches

Second choice:
Please select... Transforming Binge Eating with Innovative Body/Mind Modalities Eating Disorders and PCOS: Exploring causes, effects, and treatments for those who struggle Treating Eating Disorders with Acceptance and Values Based Approaches

Session VI

First choice:
Please select... Two Bodies in the Room: Using Authentic Connection and Self-awareness for Effective Body Image Treatment Utilizing IFS & Guided Imagery to Work with Clients Eating Disordered Parts of Self Diabulimia - When Diabetes and Body Image Collide

Second choice:
Please select... Two Bodies in the Room: Using Authentic Connection and Self-awareness for Effective Body Image Treatment Utilizing IFS & Guided Imagery to Work with Clients Eating Disordered Parts of Self Diabulimia - When Diabetes and Body Image Collide

Endnote: Ovidio Bermudez, MD, FAAP, FSAHM, FAED, CEDS

Total: $0.00