Massachusetts Peer Workforce Coalition Conference Registration
BEYOND THE CRISIS: Deeping the Dialogue on Harm Reduction, Crisis Response Systems and Equity in Lived Experience Peer Professional Roles
Name
*
First Name
Last Name
Email
*
example@example.com
Professional Role
Please Select
Recovery Coach
Certified Peer Specialist
Family Partner
Community Health Worker
Young Adult Peer Mentor
Older Adult Peer Specialist
Other Peer Provider
Other Provider
Employer / Organizational Affiliation
Organization Size
*
Please Select
I am not affiliated with an organization (No cost)
The organization I work for employs 1-25 people ($5 per person)
The organization I work for employs 25-100 people ($15 per person)
The organization I work for employs over 100 people ($30 per person)
Conference tickets are available on a sliding scale to ensure both accessibility and equity, while helping to fund the program (venue, food cost, speaker fees etc.) A follow-up email with payment details may be sent after registration. Please reach out to Shulamith Acevedo (sacevedo@kivacenters.org) with any questions or for additional scholarship information.
Please write the number of people you are registering for
If you are registering multiple individuals, please fill out the ticket information below and indicate any dietary or accessibility needs.
Ticket Holder 2
First Name
Last Name
Ticket Holder 3
First Name
Last Name
Ticket Holder 4
First Name
Last Name
Ticket Holder 5
First Name
Last Name
Do you / your group have any dietary restrictions?
Do you / your group have any accessibility requests?
Submit
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