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TRANSCRIPT
JUNE 23-25, 2020
in Denver, ColoradoSheraton Denver Downtown
1550 Court Place | Denver, CO 80202
JOIN US!
PRELIMINARY PROGRAM
GENERAL INFORMATION The School-Based Health Alliance and the Colorado Association for School-Based Health Care are proud to co-host the 2020 Convention—the premier advocacy, networking, and continuing education forum for school-based health professionals from across the nation.
HOTEL INFORMATION/CONVENTION LOCATIONSheraton Denver Downtown1550 Court PlDenver, CO 80202
HOTEL ACCOMMODATIONSA hotel room block has been secured at the Sheraton Denver Downtown for all 2020 National School-Based Health Care Convention registrants. Hotel rooms at the group rate are limited and available on a first come, first serve basis. The deadline for hotel reservations is May 31, 2020, unless the room block is sold out.
The School-Based Health Alliance does not guarantee room availability. Standard Room Rate: $249.00 plus taxes. To make reservations, call 1-888-236-2427 or 1-303-893-3333 or reserve online.
All hotel reservations must be accompanied by a room deposit for the first night or guaranteed with a major credit card. The hotel will not hold any reservations unless secured by one of the above methods.
The hotel does not provide shuttle service. Estimated taxi fare: $60 (one-way) from Denver International Airport (DEN).
Parking
On-site parking is available for $41 daily and $49 for valet. Parking is not validated for Convention participants.
DISCLOSURE STATEMENTThe School-Based Health Alliance strives to ensure balance, independence, objectivity, and scientific rigor in all of its educational programs. All faculty members participating in this program have been required to disclose any real or apparent conflict(s) of interest that may have a direct bearing on the subject matter of this program. This disclosure includes relationships with pharmaceutical companies, biomedical device manufacturers, or other corporations whose products or services are related to the subject matter of the presentation topic. The intent of this policy is to openly identify any conflict of interest so that the attendees may form their own judgments about the presentation with the full disclosure of the facts. In addition, faculty is expected to openly disclose any off-label, experimental, or investigational uses of drugs or devices in their presentations.
AMERICANS WITH DISABILITIES ACTIf you require special accommodations to attend or participate in this activity, please provide information about your requirements on the registration form or contact Alicia Newell (202-638-5872) at least five business days in advance of the convention.
CONTINUING EDUCATION The School-Based Health Alliance is applying to provide continuing education credits for general dentistry, health educators, medical doctors, nurses, pediatric nurse practitioners, and social workers. Attendees have the opportunity to earn approximately 16 hours of CEUs.
Final Convention Program will be available via Mobile App!
REGISTRATIONRegister online or complete the enclosed registration form. To receive the early bird discount, registration materials must be postmarked by May 8, 2020 (June 5, for Colorado residents). The Conference registration fee covers attendance to general session workshops, plenary sessions, two breakfasts, two lunches, and daily breaks. Not included are pre-Convention workshops, continuing education fees, membership dues, evening events, the SBHC site visit, guest food, and beverages.
Payment must be made by check or credit card (Visa and MasterCard are accepted). Purchase orders are also accepted. All payments must be made in full prior to the meeting. A $50 service fee will be charged for returned checks.
Register 5-9 people to receive a 5% discount and register 10 or more people for a 10% discount off of the Alliance general registration rate. Group discount registrations are accepted by mail or fax only. All registrations must be paid for at the same time. All other registration rate types are already discounted; therefore, a group discount is not available. If any attendee cancels—making the group ineligible for the discount—the difference will be adjusted.
Special Rates: To qualify for the student rate, you must be enrolled as a full-time undergraduate or graduate student at the time of registration. Proof of student status, in the form of a letter from your registrar’s office, must accompany your registration form. To qualify for the youth rate, you must be enrolled as a full-time high school student at the time of registration and submit completed consent and chaperone forms (available online). Workshop and lead poster presenters, along with attendees from Colorado, receive a special rate for the Convention. Registration cancellations must be in writing to the School-Based Health Alliance and must be postmarked by June 1, 2020. A $60 processing fee will be incurred. No refunds will be issued after June 1, except in case of medical illness, death, or family emergencies. Emergency cancellations must be approved by the Convention director. Refunds will not be awarded in the event of a natural disaster. Alternate attendees will be accepted in lieu of a canceled registrant. If you cannot find an alternate, please consider it as a donation.
COLORADO DAY at the 2020 National School-Based Health Care Convention is Wednesday, June 24.Coloradans are encouraged to participate in the entire three-day convention, but may pay a special one-day rate to attend COLORADO DAY only. The SBHC site visit to Florence Crittenton High School is on Thursday, June 25 (visit open to first 50 registrants and additional fee required).
COLORADO MEMBER MEETING
is on Wednesday, June 24
SCHEDULE AT A GLANCE
Click the icon to preview our session descriptions online.
$ Extra fee applies • Presenter(s) from Colorado
TUESDAY, JUNE 23
1:00pm — 5:00pm
PC1: Primary Care Clinical Skills $ Maximum Impact: Targeting SDOH with Adolescent-Focused Motivational Interview
PC2: Mental Health Clinical Skills $Screening, Brief Intervention, Referral, and Treatment (SBIRT) in School-Based Health Settings to Address Substance Use and Suicide Risk
PC3: Business/Systems $School-Based Telehealth 101: The Nuts and Bolts of Successfully Using Telehealth in Schools
1:00pm — 4:00pm
• PC4: Business/Systems How to Identify and Address Missed Coding and Billing Revenue Opportunities (Colorado Attendees Only)
4:30pm
• Colorado Association for School-Based Health Care Social Hour
WEDNESDAY, JUNE 24
8:15am — 9:30am
PL1: Roles Opening Remarks and Plenary Featuring Michele Gay, Founder and Executive Director, Safe and Sound Schools
Series A Workshops9:45am — 11:00am
A1: Primary Care Clinical SkillsVape pods, JUULs, E-cigs—Oh, My! Update on the Vaping Crisis and Current Recommendations for Management
• A2: Mental Health Clinical Skills How to Develop Strong Partnerships to Implement Violence Prevention Protocols in SBHCs—PART I
A3: Accountability/Quality ImprovementAn Implementation Approach to HIV Testing and Prevention in School-Based Health Centers
A4: PopulationChildren’s Health and Education Mapping Tool 101
• A5: Business/SystemsInnovative Uses of Marketing to Increase SBHC Awareness 3.0
A6: Oral HealthStrategies to Enhance Oral Health Awareness and Advocacy in School Dental Programs
A7: Systematically Targeted GroupsBeyond Rainbow Stickers: A Replicable Model to Create Affirming Spaces for LGBTQ+ Adolescents
• A8: Advocacy and PolicyCreating Policy for School Safety: Hear from Colorado’s Legislators
A9: Business/SystemsThe Secret Sauce to Rural School-Based Health Centers
Series B Workshops11:15am — 12:30pm
B1: Primary Care Clinical SkillsVaping, a Public Health Crisis: Treating Nicotine Dependence in SBHCs
• B2: Mental Health Clinical SkillsHow to Develop Strong Partnerships to Implement Violence Prevention Protocols in SBHCs—PART II
• B3: Accountability/Quality ImprovementTrauma-Informed Care: Case Studies of High-Scoring Adverse Childhood Experiences’ Using SBHCs
• B4: Accountability/Quality ImprovementNew Directions for SBHC Research: An Interactive Discussion
B5: Business/SystemsEnhancing SBHC Sustainability in the Managed Care Era: An Alternative Reimbursement Pilot
B6: Oral HealthSaving Smiles Through School-Based Telehealth and Interprofessional Practice
B7: Systematically Targeted GroupsUsing Health Educators from the Community to Augment Culturally Aligned School-Based Health Care
• B8: Advocacy and PolicyPolicies for Action: Mental Health as a Key Component of School Climate
B9: RolesBuilding Meaningful Partnerships with Schools: Health as an Essential Piece of the Pie
Final Convention Program will be available via Mobile App!
12:45pm — 2:15pm
PL2: Luncheon Plenary, Business Meeting, Awards (Open to all)
Series C Workshops2:30pm — 3:45pm
C1: Primary Care Clinical SkillsHoof Beats Sometimes Do Mean Zebras VIII
C2: Mental Health Clinical SkillsBest Practices Supporting Neurodiversity Among Transgender and Gender-Diverse Youth
C3: Accountability/Quality ImprovementCreating Space for the Young Person’s Voice: Youth Involvement to End Homelessness
C4: PopulationSustainable Partnerships to Address Asthma Disparities
C5: Business/SystemsLead the Way: Engaging Youth in Health Care
• C6: Oral HealthChanging the Policy and Workforce Landscape for the Colorado Virtual Dental Home
• C7: Systematically Targeted GroupsIntegrating Pre-exposure Prophylaxis (PrEP) Care into Denver Health’s SBHCs
C8: Advocacy and PolicySBHCs and Leveraging Federal Funding to Expand School-Based Services
• C9: RolesNothing About Us, Without Us: Improving Care Through Youth Partnership
Youth C: Youth ProgramHow You(th) Are the Key to Tackling the Stigma on Mental Health (Open to all)
Series D Workshops4:00pm — 5:15pm
D1: Primary Care Clinical SkillsCounseling Adolescents to Resist Sexual Coercion
D2: Mental Health Clinical SkillsHow Do We Serve the Underserved? Integrating School-Based Behavioral Health
D3: PopulationMeeting Children Where They Are: Models for the 21st Century School-Based Mental Health Clinic
D4: PopulationPatient Navigation: Innovative Methods for Reaching Patients Where They Are
D5: Business/SystemsGuiding School Health Service Through Needs Assessment and Action Planning
D6: Primary Care Clinical SkillsResults from a Body-Positive and Trauma-Informed Intervention for BMI-Related Visits
D7: Mental Health Clinical SkillsDisconnecting the School-to-Prison Pipeline: Examining Integrated Behavioral Health in SBHCs
D8: Accountability/Quality ImprovementImproving Nurse Satisfaction with School Telemedicine
D9: RolesBuilding Trauma-Sensitive Environments
5:30pm
• Colorado Association for School-Based Health Care Member Meeting
THURSDAY, JUNE 25
8:15am — 11:00am
• SV: Roles $Denver Health Florence Crittenton SBHC Tour
Primary Care Clinical SkillsClinical Training Program for NEXPLANON sponsored by Merck (Not accredited for continuing education credit and attendees must meet specific requirements)
Series E Workshops8:15am — 9:30am
• E1: Primary Care Clinical SkillsMaking Schools Safer: Addressing Youth Violence Through School-Based Health Care—PART I
• E2: Mental Health Clinical SkillsSBIRT in Action: Collaborating with Schools to Address Substance Use
E3: Accountability/Quality ImprovementThe State and Impact of Reproductive Health in SBHCs
E4: PopulationA Multistate Collaboration on Youth Opioid Resources and Programs
E5: Business/SystemsBest Practices for Telehealth Training: Preparing Providers and Presenters—PART I
E6: Oral HealthJust for Grins: Bringing Oral Health Messaging into the Classroom
E7: Systematically Targeted GroupsMeeting the Needs of Immigrant Youth in School Health Services
E8: Accountability/Quality ImprovementCollaborating for Quality: State Program Partnerships Working to Enhance SBHC Compliance
E9: RolesProviding a Value for Families with Collaborated Telemedicine Programs in Schools
Series F Workshops9:45am — 11:00am
• F1: Primary Care Clinical SkillsMaking Schools Safer: Addressing Youth Violence Through School-Based Health Care—PART II
F2: Mental Health Clinical SkillsDeveloping and Implementing Tele-behavioral Health at an SBHC
F3: Accountability/Quality ImprovementYouth-Centered Design, EHR Integration, and Confidentiality to Increase Universal Screening
• F4: PopulationTalking to Young People: Web-Based Support for Educating Youth on Vaping, JUULs, and Electronic Nicotine Devices
F5: Business/SystemsBest Practices for Telehealth Training: Preparing Providers and Presenters— PART II
F6: Primary Care Clinical SkillsOpen Wide, Look Inside! Oral Assessment, Treatments, and Referral Resources
$ Extra fee applies • Presenter(s) from Colorado
F7: Mental Health Clinical SkillsPsychological First Aid: How to Respond to a Traumatic Event in Your School as a Mental Health Provider
F8: Systematically Targeted GroupsA Path to Crisis Recovery and Resilience: Working with Native Communities
F9:RolesAn Integrated Approach to Youth Mental Health: Collaborating for Wellness and Resilience
11:15am — 12:45pm
PL3: Lunch with Exhibitors and Poster Session (Open to all)
Series G Workshops1:00pm — 2:15pm
G1: Primary Care Clinical SkillsAdvanced Patient-Centered Counseling Skills—PART I
G2: Mental Health Clinical SkillsGetting to a Tipping Point: Advancing Quality Comprehensive School Mental Health Systems Within SBHCs
G3: Accountability/Quality ImprovementShare and Tell: SBHCs Quality Improvement Research
G4: PopulationHow to Add Vision Services to Your Existing Wellness Center
G5: Business/SystemsHow Elevating SBHC National Performance Measures Can Improve Business Practices
G6: Primary Care Clinical SkillsLeveraging your SBHC for Cancer Prevention: A School-Based Approach to HPV Vaccination
• G7: Mental Health Clinical SkillsWhy is Cultural Awareness Necessary to Engage Families in SBHCs?
• G8: Primary Care Clinical SkillsValue-Based Reimbursement in an E/M World: Why Problems Matter
G9: RolesA Formula for Health: SBHCs and School Wellness Teams
Series H Workshops2:30pm — 3:45pm
H1: Primary Care Clinical SkillsAdvanced Patient-Centered Counseling Skills—PART II
H2: Mental Health Clinical SkillsBeyond Behavioral Health Screening: Integrating Primary Medical and Behavioral Health Care Services in SBHCs
H3: Accountability/Quality ImprovementQuality Counts and Beyond: Advancing Los Angeles’ SBHCs through the Data xChange
H4: PopulationThe Lagniappe of Louisiana’s School-Based Health Investment
H5: Business/SystemsRoadmap for Funding a School-Based, Sustainable, Nurse-led Clinic
H6: Oral HealthOral Health in Schools: Linking Oral, Physical, and Mental Health with Dental Neglect
H7: RolesTeamwork to Dream Work: How to Build Community Partnerships to Make Dreams a Reality
H8: RolesEngagement to Improve Health, Attendance, and Student Academic Outcomes
4:00pm — 5:15pm
PL4: Role: Closing Remarks and Plenary Featuring Dr. Nita Mosby Tyler, Chief Catalyst and Founder, The Equity Project LLC
5:30pm
School-Based Health Alliance Member Meeting and Social Hour
$ Extra fee applies • Presenter(s) from Colorado
WEDNESDAY, JUNE 249:45am — 12:15pm(No break taken in-between A and B)
Youth A/B: Youth Program Health Communication 101: A Skills-Based Approach to Youth-Led Health Promotion
2:30pm — 3:45pm
Youth C: Youth ProgramHow You(th) Are the Key to Tackling the Stigma on Mental Health
4:00pm — 5:15pm
Youth D: Youth ProgramUsing Young Adult Fiction to Spark Public Health Advocacy Among Youth
THURSDAY, JUNE 258:30am — 11:00am(No break taken in-between E and F)
Youth E/F: Youth ProgramHealth Care Simulation Activity
1:00pm — 2:15pm
Youth G: Youth ProgramThat’s the Spot: Acupressure for Self-Care and Health Promotion Among Teenagers
2:30pm — 3:45pm
Youth H: Youth ProgramYouth Program Wrap-Up
‘ BE THE CHANGE’ YOUTH TRAINING PROGRAM
Final Convention Program will be available via Mobile App!
First Name: Last Name:
Title: Degree(s):
Organization:
Organization Mailing Address:
City: State: Zip:
Work Phone: E-mail:
If you are a presenter, please enter your workshop slot, ex. A2, B5:
Fax to: (202) 638-5879 or Mail to: School-Based Health Alliance, 1010 Vermont Ave., NW, Suite 600 Washington, DC 20005
Conference Fees (check your choice) Before May 8 After May 8
*General Registration o $550 o $600Presenter Registration o $500 o $550Student (undergrad or grad) o $400 o $425 Fax letter from registrar (202) 638-5879Youth (high school) o $200 o $200 $100 rate for first 25 registrants
Pre-Conference Workshops Not available for purchase onsite.
PC1: Tue, June 23, 1:00pm-5:00pm o $100 o $120 (limit: 30 seats)PC2: Tue, June 23, 1:00pm-5:00pm o $100 o $120PC3: Tue, June 23, 1:00pm-5:00pm o $100 o $120PC4: Tue, June 23, 1:00pm-4:00pm o $0 o $0 (Colorado attendees only)
Optional Items Guest for Food Events Only (Adult) o $125Guest for Food Events Only (Age 4-17) o $75Site Visit: Thu, June 25, 8:15am-11:00am o $35
Continuing Education (Select one)o CME, CNE, CHESo Social Work o NAPNAP o Dental o $55
Donationso Unrestricted Funds o Youth Funds __________
Membership RenewalIndividual o $100Organization o $500
Subtotal: Conference Fee __________
Pre-Conference Fee __________
Optional Items __________
Continuing Education __________
Donation __________
Membership __________
TOTAL DUE: __________
* Discounted rates available for groups of 5 or more on generalregistration. Please call (202) 638-5872 for more information.
Guest meals: Breakfast and Lunch Wednesday and Thursday.
Workshop SessionsPlease enter the number of the workshop sessions that are your first and second choices. We will make every effort to place you in your first choice session.
1st Choice 2nd ChoiceWednesday, June 24 Session A Workshops 9:45-11:00am __________ __________Session B Workshops 11:15-12:30pm __________ __________Session C Workshops 2:30-3:45pm __________ __________Session D Workshops 4:00-5:15pm __________ __________
Thursday, June 25 Session E Workshops 8:15-9:30am __________ __________Session F Workshops 9:45-11:00am __________ __________Session G Workshops 1:00-2:15pm __________ __________Session H Workshops 2:30-3:45pm __________ __________
‘Be the Change’ Youth Program
I will attend the following events. Please select yes or no:PL1 : Opening Plenary Wed, June 24, 8:15am-9:30am o yes o no
PL2: Luncheon Plenary/Business Meeting Wed, June 24, 12:45pm-2:15pm o ❏yes o no
PL3: Lunch with Exhibitors/Poster Session/Awards Thu, June 25, 11:15am-12:45pm ❏ o yes❏ o no
PL4: Closing Plenary Thu, June 25, 4:00pm-5:15pm o ❏yes o no
Special Needs:
Food Restrictions:
Payment Methodso Check (payable to School-Based Health Alliance)
o Visa o MasterCard o AmEx o Discover
Name on Card:
Card Number:
Exp. Date: Billing Zip Code: Security Code:
Federal ID Number: 54-1752058
REGISTRATION (MEMBER)
First Name: Last Name:
Title: Degree(s):
Organization:
Organization Mailing Address:
City: State: Zip:
Work Phone: E-mail:
If you are a presenter, please enter your workshop slot, ex. A2, B5:
Fax to: (202) 638-5879 or Mail to: School-Based Health Alliance, 1010 Vermont Ave., NW, Suite 600 Washington, DC 20005
Conference Fees (check your choice) Before May 8 After May 8
*General RegistrationPresenter Registration $ $600 Student (undergrad or grad) $480 Fax letter from registrar (202) 638-5879Youth (high school) $200 $200 $100 rate for first 25 registrants
Pre-Conference Workshops Not available for purchase onsite.
PC1: Tue, June 23, 1:00pm-5:00pm $100 $120 (limit: 30 seats)PC2: Tue, June 23, 1:00pm-5:00pm $100 $120PC3: Tue, June 23, 1:00pm-5:00pm $100 $120PC4: Tue, June 23, 1:00pm-4:00pm $0 $0 (Colorado attendees only)
Optional Items Guest for Food Events Only (Adult) $125Guest for Food Events Only (Age 4-17) $75Site Visit: Thu, June 25, 8:15am-11:00am $35
Continuing Education (Select one) CME, CNE, CHES Social Work NAPNAP Dental $55
Donations Unrestricted Funds Youth Funds __________
Membership RenewalIndividual $100Organization $500
Subtotal: Conference Fee __________
Pre-Conference Fee __________
Optional Items __________
Continuing Education __________
Donation __________
Membership __________
TOTAL DUE: __________
* Discounted rates available for groups of 5 or more on generalregistration. Please call (202) 638-5872 for more information.
Guest meals: Breakfast and Lunch Wednesday and Thursday.
Workshop SessionsPlease enter the number of the workshop sessions that are your first and second choices. We will make every effort to place you in your first choice session.
1st Choice 2nd ChoiceWednesday, June 24 Session A Workshops 9:45-11:00am __________ __________Session B Workshops 11:15-12:30pm __________ __________Session C Workshops 2:30-3:45pm __________ __________Session D Workshops 4:00-5:15pm __________ __________
Thursday, June 25 Session E Workshops 8:15-9:30am __________ __________Session F Workshops 9:45-11:00am __________ __________Session G Workshops 1:00-2:15pm __________ __________Session H Workshops 2:30-3:45pm __________ __________
‘Be the Change’ Youth Program
I will attend the following events. Please select yes or no:PL1 : Opening Plenary Wed, June 24, 8:15am-9:30am yes no
PL2: Luncheon Plenary/Business Meeting Wed, June 24, 12:45pm-2:15pm ❏yes no
PL3: Lunch with Exhibitors/Poster Session/Awards Thu, June 25, 11:15am-12:45pm ❏ yes❏ no
PL4: Closing Plenary Thu, June 25, 4:00pm-5:15pm ❏yes no
Special Needs:
Food Restrictions:
Payment Methods Check (payable to School-Based Health Alliance)
Visa MasterCard AmEx Discover
Name on Card:
Card Number:
Exp. Date: Billing Zip Code: Security Code:
Federal ID Number: 54-1752058
REGISTRATION (NON-MEMBER)
$660 $720$660$490
First Name: Last Name:
Title: Degree(s):
Organization:
Organization Mailing Address:
City: State: Zip:
Work Phone: E-mail:
If you are a presenter, please enter your workshop slot, ex. A2, B5:
Fax to: (202) 638-5879 or Mail to: School-Based Health Alliance, 1010 Vermont Ave., NW, Suite 600 Washington, DC 20005
Conference Fees (check your choice)
General Registration o $500 o $550o $195 o $240Colorado Day Registration (Weds. Only)
Student (undergrad or grad) o $400 o $425
Fax letter from registrar (202) 638-5879 Youth (high school) o $200 o $200 $100 rate for first 25 registrants
Pre-Conference Workshops Not available for purchase onsite.
PC1: Tue, June 23, 1:00pm-5:00pm o $100 o $120 (limit: 30 seats)PC2: Tue, June 23, 1:00pm-5:00pm o $100 o $120PC3: Tue, June 23, 1:00pm-5:00pm o $100 o $120PC4: Tue, June 23, 1:00pm-4:00pm o $0 o $0 (Colorado attendees only)
Optional Items Guest for Food Events Only (Adult) o $125Guest for Food Events Only (Age 4-17) o $75Site Visit: Thu, June 25, 8:15am-11:00am o $35
Continuing Education (Select one)o CME, CNE, CHESo Social Work o NAPNAP o Dental o $55
Donationso Unrestricted Funds o Youth Funds __________
o $75Membership Individual Associate o $250
Subtotal: Conference Fee __________
Pre-Conference Fee __________
Optional Items __________
Continuing Education __________
Donation __________
Membership __________
TOTAL DUE: __________
Colorado attendees receive a special registration rate. Must have discount code to qualify for Colorado Member rate.
Guest meals: Breakfast and Lunch Wednesday and Thursday.
Workshop SessionsPlease enter the number of the workshop sessions that are your first and second choices. We will make every effort to place you in your first choice session.
1st Choice 2nd ChoiceWednesday, June 24 Session A Workshops 9:45-11:00am __________ __________Session B Workshops 11:15-12:30pm __________ __________Session C Workshops 2:30-3:45pm __________ __________Session D Workshops 4:00-5:15pm __________ __________
Thursday, June 25 Session E Workshops 8:15-9:30am __________ __________Session F Workshops 9:45-11:00am __________ __________Session G Workshops 1:00-2:15pm __________ __________Session H Workshops 2:30-3:45pm __________ __________
‘Be the Change’ Youth Program
I will attend the following events. Please select yes or no:PL1 : Opening Plenary Wed, June 24, 8:15am-9:30am o yes o no
PL2: Luncheon Plenary/Business Meeting Wed, June 24, 12:45pm-2:15pm o ❏yes o no
PL3: Lunch with Exhibitors/Poster Session/Awards Thu, June 25, 11:15am-12:45pm ❏ o yes❏ o no
PL4: Closing Plenary Thu, June 25, 4:00pm-5:15pm o ❏yes o no
Special Needs:
Food Restrictions:
Payment Methodso Check (payable to School-Based Health Alliance)
o Visa o MasterCard o AmEx o Discover
Name on Card:
Card Number:
Exp. Date: Billing Zip Code: Security Code:
Federal ID Number: 54-1752058
REGISTRATION (COLORADO ATTENDEE)
CASBHC Member through June 5
CASBHC Non-Member/Member after June 5