WESTERN BRANCH CANADIAN PSYCHOANALYTIC SOCIETY ANNUAL CONFERENCE REGISTRATION FORM
Saturday March 19 th, 2005
8:15 am - 4:45 pm
Name:
Address:
Phone: Fax:
Email:
Regular Student/Group[(5+) Regular after Mar 1 Students/group(5+) after Mar 1 Choose Pmt Type
Regular……………………………$175.00 Students/Group(5+)…….……….$120.00 Registration after March 1 st, 2005 Regular…………………………...$200.00 Students/group (5+)……………..$140.00
Payable to: Western Branch - CPS Mail to: Western Branch - CPS c/o Nancy Briones, 7755 Yukon Street, Vancouver, B.C. V5X 2Y4