Conference Registration Form
I would like to pay by (please tick as appropriate):
cheque US$/£ (payable to the Journal of Analytical Psychology)
credit/debit card (An extra 3% will be charged if paying by credit card)
VISA MASTERCARD MAESTRO AMERICAN EXPRESS
Card Number:
Card valid from: Card expiry date:
Issue Number: Date:
Name: _______________________________________________________________________
Address: ____________________________________________________________________
Post Code: __________________________ Telephone: _____________________
Fax _______________________________ Email: _______________________
Signature: __________________________________________________________________
Profession (please tick as appropriate):
analytical psychologist
psychoanalyst
trainee in analytical psychology/psychoanalysis (please specify)
mental health practitioner or student (please specify)
other (please specify)
Fee enclosed (give dates of arrival and departure):
Single:
Double/Twin:
Total enclosed $/£ _______
Cancellations
Cancellations will be accepted up to 31st March 2009 with a refund less a US$120 / £60 administrative fee. No refunds will be made after that date.
Registration forms with payment should be sent to:
JAP, 1 Daleham Gardens, London NW3 5BY
or e-mailed to: journal@jap.thesap.org.uk
