Close-Ups: Psychoanalysts Look at Film Registration

Name:__________________________________________________

Address:________________________________________________

Phone:_________________________________________________

E-mail Address:_________________________________________

No. of series tickets___________ x 4 =_________________ tickets

No. of individual film tickets:

1)      4/11________ 2) 4/18________ 3) 4/25______ 4) 5/2_______

Student at:________________________________________________

Amount Enclosed:_______________________________________

Refunds will be given for cancellations made no later than one week

prior to the program.