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Self Psychology Page | Conference Brochure and Information
Direct all inquiries to:
PROFESSIONAL CONFERENCE
MANAGEMENT, INC.
7916 Convoy Court
San Diego, California 92111-1212
USA
Email: pcminc@pcmisandiego.com
Phone: 619-565-9921
Fax: 619-565-9954
CONFERENCE REGISTRATION FORM
21st Annual International Conference on The Psychology of The Self
Make checks payable to Self Psychology Fund. Full payment must accompany registration form. All fees must be paid in U.S. funds drawn against a U.S. bank. VISA and MasterCard also will be accepted. Please use one form per registration. Form may be photocopied.
(Please print or type)
Last Name _______________________________
Degree(s) ______________
(to be printed on your name tag)
First Name ______________________________
Middle Initial _________
Address _____________________________________________________
City ______________________________________State _________
Postal Code ______________Country __________________________
Phone Number (_____) ______________________________
Fax Number (_____)________________________________
E-Mail Address________________________________________________
Profession____________________________
State Professional License
No._______________________________
(for Continuing Education Certificate)
Mailing Label Code__________________________ (To help us minimize multiple mailings, please list the number or code found on the brochure mailing label even if it was not addressed to you.)
| OPTIONAL THURSDAY AFTERNOON WORKSHOPS | Postmarked By Sept. 17 | Postmarked After Sept. 17 |
| $ 45 | $ 60 | |
| Optional Thursday Afternoon Workshops (Select one): | A. Introduction to Self Psychology | |
| B. Child Therapy | ||
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| PRE-CONFERENCE PROGRAM REGISTRATION FEES | Postmarked by Sept. 17 | Postmarked after Sept. 17 |
| If taken with Main Conference | $135 | $160 |
| Student*, if taken with Main Conference | $ 70 | $ 80 |
| Pre-Conference Only | $160 | $185 |
| Pre-Conference Only - Student* | $ 90 | $100 |
Pre-Conference Courses (Select one):
| 1. Advanced Course | 3. Group Therapy Course |
| 2. Child Therapy Course | 4. Marital and Family Therapy Course |
NOTE: PRE-CONFERENCE ADVANCED COURSE
If you are registering for the Pre-Conference Advanced Course, you will be assigned to a Master Class. YOU MUST ATTEND THE GROUP TO WHICH YOU ARE ASSIGNED. We regret that exceptions and/or special requests cannot be granted.
*Student registrations MUST be accompanied by a letter from the Training Director verifying full-time status. Photocopies of student ID will not be accepted.
| MAIN CONFERENCE REGISTRATION FEES | Postmarked By Sept. 17 | Postmarked After Sept. 17 |
| Professional | $325 | $355 |
| Student* | $195 | $215 |
*Student registration MUST be accompanied by a letter from the Training Director verifying full-time status. Photocopies of student ID will not be accepted.
Because meeting room capacities are limited by local fire laws, maximum capacities will be strictly adhered to for the concurrent sessions. We regret that we are unable to make exceptions. To avoid disappointment, we urge you to register early to be assured of attending your preferred sessions.
ORIGINAL PAPERS AND WORKSHOPS
Please refer to the program and indicate your preferences in the spaces provided.
SESSION A: Saturday Morning 8:30 am - 10:00 am
1st Choice No._____ 2nd Choice No._____ 3rd
Choice No._____
4th Choice No._____ 5th Choice No._____
SESSION B: Saturday Morning 10:30 am - 12:00 pm
1st Choice No._____ 2nd Choice No._____ 3rd
Choice No._____
4th Choice No._____ 5th Choice No._____
SESSION C: Sunday Morning 8:30 am-10:00 am
1st Choice No._____ 2nd Choice No._____ 3rd
Choice No._____
4th Choice No._____ 5th Choice No._____
OPTIONAL SATURDAY LUNCHEON FOR CONFERENCE PARTICIPANTS
An optional luncheon will be held on Saturday beginning at 12:15 pm. The fee for the lunch will be $35 in advance, $40 at the conference (based on space availability).
GUEST TICKETS
Guest tickets may be purchased for the Saturday Luncheon, Saturday Evening Reception, or Continental Breakfasts and Reception combined.
| In Advance | At the Conference | |
| Guest Conference Reception Ticket | $30 | $35 |
| Guest Breakfast & Conference Reception Tickets | $60 | $65 |
| Guest Luncheon Ticket | $35 | $40 |
Guest's Name_______________________________________________
Will you need any special assistance at the conference? Please list your needs:
__________________________________________________________
__________________________________________________________
Totals:
| Optional Thursday Afternoon Workshop | $_________ |
| Pre-Conference Program Fee | $_________ |
| Main Conference Program Fee | $_________ |
| Optional Luncheon for Registrants | $_________ |
| Guest Tickets | $_________ |
| TOTAL AMOUNT DUE | $_________ |
| Select One: | ||
| A check is enclosed payable to Self Psychology Fund. | ||
| Bill my: | VISA | MASTERCARD |
Account
#___________________________________________________
Exp. Date__________________
Signature______________________________________
(as it appears on the card)
Mail to:
Self Psychology Conference
7916 Convoy Court
San Diego, CA 92111
A $20.00 fee will be assessed for returned checks.
NOTE: Please make hotel reservations directly with The Hotel Del Coronado.