Registration Form
(Please print and mail)
Parking $11.00 paid on day of conference.
Registration Fee:
$55 general; $30 full time students and active
military, who must enclose official documentation of their status.
Continental breakfast and boxed lunch are
included with advance registration.
Registration deadline:
January 25, 2008
Name___________________________________________________
Discipline/Degree_______________________________________
_________________________________________________________
Address_________________________________________________
_________________________________________________________
City/State/Zip
___________________________________________
Telephone:______________________________________________
Email:___________________________________________________
Fax:_____________________________________________________
Note:
Please contact us in advance of the conference
if you need any special accommodations to allow you to participate fully.
Checks Payable to: Ann Aukamp, Treasurer, CPR
Please send Registration Form and Check to:
Ann Aukamp, Treasurer
Consortium for Psychoanalytic Research, Inc.