HOPE 2018 Registration Form

Circle your 1st, 2nd, and 3rd choice selection for each of the three sessions.

Session A 9:45am – 11am
1st Choice    A1  A2  A3   A4   A5   A6
2nd Choice  A1  A2  A3   A4   A5   A6
3rd Choice   A1  A2  A3   A4   A5   A6

Session B 11:15am – 12:30pm
1st Choice    B1  B2  B3   B4   B5  B6
2nd Choice  B1  B2  B3   B4   B5  B6

3rd Choice   B1  B2  B3   B4   B5  B6
Session C 2:30pm – 3:45pm

1st Choice    C1  C2  C3   C4    C5
2nd Choice  C1  C2  C3   C4    C5
3rd Choice   C1  C2   C3   C4   C5

Registrations accepted with a check or
PO# only. $15 before May 23 | $20 after May 23Mail or fax this form with a check payment or
PO #________ to:


Fax – 207-878-3172


Attn: HOPE Conference
Co-Occurring Collaborative Serving Maine
94 Auburn Street, Suite 110
Portland, Maine 04103


Conference volunteers who sign up by
May 14 receive free registration.  Must contact
Melissa Caswell at mcaswell@maineccsm.org







city, state _______________­­­_____________ zip___________




I identify as a: ¨ Peer/Consumer ¨ Provider ¨ Consumer and Provider

___I will need an American Sign Language Interpreter.

___I will be accompanied by an attendant.

___ I live 130 or more miles one way from the Augusta Civic Center and qualify for lodging reimbursement. Peers and Consumers ONLY

___I live 150+ round trip miles away and traveled in my own vehicle. Peers and Consumers ONLY

I am able to volunteer during the week of May 21___or the day May 30 ____ Contact Melissa Caswell at mcaswell@maineccsm.org
Cancellation Policy – There will be no refunds for cancellations given the week of the conference. Cancellations provided more than one week in advance will receive a partial refund. Please provide your name and address to where you would like the refund check mailed. Contact ccsme@www.ccsme.org | 878-6170.