Registration Form:

WBCPS ANNUAL SCIENTIFIC MEETING

“Becoming an individual: a psychoanalytic journey with a schizoid-deprived patient”

Saturday March 24 th, 2007

COST

Regular…………………………$175.00 CAD/$150.00 USD
Students…….…….$120.00

Registration after March 1st, 2007

Regular………………………….$200.00 CAD /$175.00 USD
Students……….…..$140.00

Name: Member Non-member Student

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

ASM Organizing Committee:
Endre Koritar, MD, FRCP(C) Chair
Elie Debbane, MD, FRCP(C)
Judith Setton-Markus, M.Ed.
Lynne Superstein-Raber, Ph.D
Joanne Leithead, M.Ed.