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Registration
2015 Anxiety and Depression Conference
April 9–12, 2015
To complete electronically: Download, save to computer; or print out, write legibly, scan; email to [email protected]
First name ____________________________ Last name ______________________________________________
Degree(s) _________ Badge name (if different from above) _____________________________________________
Current affiliation (as it should appear on your badge) __________________________________________________
Preferred mailing address (This is my ☐ home ☐ work.)
Street _______________________________________________________________________________________
City ________________________________ State ______ Zip/Postal code ___________ Country _____________
Phone ___________________ Fax ___________________ Email _______________________________________
Emergency contact _______________________________________________ Phone _______________________
Members
Current membership must be paid through April 30, 2015, to qualify for memberdiscounted rates. Join ADAA now.
Through October
31, 2014
Professionals
$420
Until March 1,
2015
After March 1,
2015
Nonmembers
Until March 1,
2015
After March 1,
2015
$755
+ $55 for
CE or CME
$815
+ $55 for
CE or CME
$470
$530
Trainees/Postdoctoral Fellows/Residents
(includes box lunch on Saturday)
$260
$280
$385
$405
Students (includes box lunch on Saturday)
$170
$200
$235
$275
Thursday only (Master Clinicians; PCORI;
NIMH)
$160
$190
$195
$245
Preconference Workshop With Reid Wilson
(this ticketed event only)
$170
$195
$215
$250
Preconference Workshop With Reid Wilson (fee
for this ticketed event when you register for the
full conference)
$95
$95
$125
$125
Consumers
$145 (through April 12, 2015)
Guests: name(s)________________________
$95 (through April 12, 2015)
Will you be attending Thursday programs: Master Clinicians, PCORI, NIMH, or research sessions? ☐ yes
☐ no
If you are registered as a student or trainee/postdoctoral fellow/resident, will you be attending the Early Career lunch
(Saturday, included in fee)? ☐ yes ☐ no
☐ I am applying for CE or CME credits (professionals only)……….....☐ $0 for ADAA members ☐ $55 for nonmembers

Check one for CE or CME credits…………☐ CME ☐ CME-MOC
☐ APA
☐ NASW
☐ NBCC ☐ Other
☐ I agree to comply with the ADAA conference registration and cancellation policies (below).
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Payment Information
☐ Check #__________
Checks must be in US $ and payable to ADAA.
☐ VISA ☐ MasterCard
T OTAL $_______
ADAA does not accept American Express or Discover.
Credit card number ___________________________________ Expires ________ 3- or 4-digit security code _________
Authorized Signature _________________________________________________ Date: ________________________
ADAA fully complies with the legal requirements of the Americans with Disability Act (ADA). Please list any special
requirements:_______________________________________________________________________________________
Complete both pages of this form and email to [email protected] or mail with full payment to
Conference Registration, ADAA, 8701 Georgia Avenue, Suite 412, Silver Spring, MD 20910
Questions? Call ADAA at 240-485-1030 or e-mail [email protected] | FAX 240-485-1035
ADAA CONFERENCE REGISTRATION AND CANCELLATION POLICIES
Cancellation and Refunds Cancellations and requests for refunds must be received in writing by March
9, 2015; cancellations by telephone will not be accepted. A $75 administrative fee will be charged for all
refunds. Refunds will be issued after the conference ends.

Cancellations will not be accepted after March 9, 2015, for any reason, including medical and travel
complications, due to the many costs associated with planning and organizing this conference.
Registration Everyone attending the 2015 Anxiety and Depression Conference must register and pay
the appropriate registration fee. All session and poster presenters must register immediately upon
acceptance to the program. After March 23, 2015, registration will be available on-site only.



Students, trainees, postdoctoral fellows, and residents: You must provide a letter from your
institution to be eligible for special reduced fees.
Guest fees—nonprofessional adults (family members and guests) who accompany
registrants—provide access to non-ticketed meals and receptions. Guests are not eligible for
CE or CME.
Consumers: Register by phone (240-485-1030) or by mail by March 23, 2015,
or on-site.
(Mail to ADAA, 8701 Georgia Ave., Suite 412, Silver Spring, MD 20910) Health
professionals, faculty, and research staff are not eligible for consumer rates.
Confirmation and Badges Registrants will receive confirmation by e-mail. Badges and conference
information will be mailed three weeks before the meeting. You must bring these items with you to
the conference. Badges are required for admission to sessions and must be worn at all times. Badge
holders and conference programs will be distributed on-site.
Payment Payment in full is required at time of registration. ADAA accepts VISA or MasterCard, and
checks or money orders in U.S. dollars ($30 charge for checks returned for insufficient funds). ADAA
does not accept purchase orders, American Express, or Discover.
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