2017 Mind Matters Conference Registration

Contact Information

Name:
Organization:
Address:
City:
State:   Zip Code:
Phone:
Email:
Special Needs: Please provide a written request for any special needs, including dietary.

Registration Fees

 Full Conference Registration = $200

 Friday only = $125

 Saturday only = $125

 Special Rate for Survivor (or immediate family member) * = $50

* In order to receive this special rate, the applicant:

  • Must be an individual with a traumatic brain injury or immediate family member
  • Must be a resident of North Dakota
  • Can NOT be agency or professional staff
  • Will be contacted by NDBIN to verify eligibility for scholarship rate

Breakfast, lunch, and snacks included for each day. Costs not covered: hotel expenses, mileage/flight costs, off-site meals and dinner.

Payment

Once you submit this form, you will receive an invoice via email with payment instructions. Only checks are accepted. If you do not receive this within two business days please contact Michelle Graba at 701-777-3294.

The North Dakota Brain Injury Network periodically sends information on events, presentations, and news related to brain injury. As an attendee of the Mind Matters Conference, your email will automatically be included to receive these updates. Your contact information will not be sold or shared.

 I wish to opt out of having my contact information included.