Western Branch Canadian Psychoanalytic Society

Scientific Program 2007
Registration Form:

Cost: Members: No charge
Non-Members: $35.00 per event
Students: $30.00 per event

• I wish to attend all 4 events: Yes: Not sure:
• If you wish to attend all four please remit your cheque payable to WBCPS for the total amount indicated above.

January 20, 2007: Endre Koritar, MD, FRCPC

May 5, 2007: Robert Oelsner, FIPA

September 8, 2007: Hassan Azim, MD, FRCPC

November 17, 2007, 2007: Martin Gauthier, MD

Name: Member Non-member Student Candidate

Address:

Phone number: Email address:

Professional Affiliation:

Make cheques payable to: Western Branch-CPS

Mailregistrations to:
Western Branch-CPS
c/o Nancy Briones,
7755 Yukon Street,
Vancouver, B.C. V5X 2Y4