Registration – In Person (student) – Northern New England Society of Addiction Medicine

Name *

First

Last

Student Type (Pick the one that best describes you) *

Major, Specialty, Field or Discipline *

School or Program *

Are you an ASAM member? *

Student ASAM members should choose student discount option for the least expensive registration fee.

Are you a NNESAM member? *

Student ASAM/NNESAM members should choose student option for the least expensive registration fee.

Email *

City *

State *

Please list any food allergies(or indicate "none"): *