First Responder Crisis & Mental Health Conference Attendee Registration
Complete this registration only if you are a First Responder wanting to attend the conference. Vendors and sponsors, please use the vendor/sponsor form.
Name
*
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Department Employed by
*
Type of CEU/CE/Certificate of Completion Requested (LEO, EMS, Fire, Social Work, etc.)
*
How did you hear about this conference?
*
What Size T-Shirt
Medium
Large
X-Large
XX-Large
Please Select the Wellness and Peer Connection Events you plan to attend.
Night one open reception
Night two winery and live music
Closing day sunrise breakfast
Other
My Products
*
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2026 Las Cruces Conference Registration Fee
$250.00
$
250.00
Payment Methods
Choose from one of the PayPal options to
make your payment.
Submit
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