VA Psychology Summit
Engaging Partners in Shaping the Future of VA Care

Register for the Conference

To register for the 2017 VA Psychology Psychology Summit, you must pay with a credit card through PayPal. Complete the form below and click the "Submit" button to go to the payment page. Only credit card payments are accepted to register for the conference. Registration fee for the VA Psychology Summit is $40 per person.

Note: If the name on the PayPal account is different from the name of the registrant, please insert the PayPal account name in the appropriate box at the end of the form so that we may connect this form with the payment.

If your plans change and you are unable to attend the conference after registering, full refunds will be issued if you cancel before July 24, 2017. Unfortunately, no refunds will be issued after July 24, 2017. Please do NOT issue a "chargeback" through your credit card company. Please contact Dr. Samuel Wan if you desire a refund.

Thanks for your interest in the Summit!

First Name:  
Last Name:  
Job Title:  
Street Address:  
Address (cont.):  
ZIP Code:  
Work Phone:  
E-mail Address:  

I am registering to attend the Washington, DC Summit (August 2, 2017)

If someone other than the registrant named above will be paying the registration fee (e.g., registrant's spouse or significant other, or if the name on your PayPal account is different from your full name listed above), please enter the name of person that is associated with the credit card being used to charge the registration fee in the box below:
Dietary Restrictions:  

Click the "Submit" button below to submit your application electronically and to go to an internet site where you can enter your credit card information. Click "Reset" to clear the above information and start over.