REGISTRATION FORM
Division 39, APA
37th Annual Spring Meeting
April 26-30, 2017
New York City

NOTE: ALL STUDENTS and INSTITUTE CANDIDATES MUST submit proof of their status WITH registration. Without this proof, your registration will not be processed.

"Student Proof" is an official document that has the school logo and/or letterhead that specifically states that you are enrolled full-time for the current semester or provides information (i.e., a paid bill or transcript, a letter from the registrar, etc.) that supports that enrollment. A student ID is NOT "proof."

Candidates in Analytic Institutes who wish to register at the special fee must include with their registration form a letter from an administrator at their institute stipulating that they are a candidate in good standing in the first five years of their training."

If you are mailing or faxing your registration form, please submit such "proof" with that form. If you are submitting your registration form online, please submit the letter/proof by fax to (301) 986-8647 or by email attachment to HankLewis@natalieshear.com.

 

()-                                          
Yes         No
Yes         No
Yes         No
Postmarked or electronically submitted by 4/12/2017
Member $470
Non Member
Please add $95 to my registration fee for a Division 39 Membership, and charge me the member rate.
$550
Student Member $70
Student Non Member
$25 of all student non-member registrations will be applied to a one-year Division 39 Membership
$95
ECP Member (Date of Doctoral Degree April 2007 or later) $175
ECP Non Member (Date of Doctoral Degree April 2007 or later)
Please use $50 of my registration fee towards Division 39 Membership
$210
Institute Candidate member (Enrolled in first 5 yrs of curriculum only) $175
Institute Candidate Non Member (Enrolled in first 5 yrs of curriculum only)
Please use $95 of my registration fee towards Division 39 Membership
$245

Foreign Affiliates Postmarked or electronically submitted by 4/12/2017
Current Division 39 Members: Canada, Western Europe, Australia, New Zealand, Japan $380
Current Division 39 Members Other Countries: South America, Africa, Asia, Middle East $200
Non-Division 39 Members: Canada, Western Europe, Australia, New Zealand, Japan
Add $65 to my registration fee for a one-year Division 39 Membership
I am a Student, add $20 to my registration fee for a one-year Division 39 Membership
I am an ECP, add $35 to my registration fee for a one-year Division 39 Membership
$405
Non-Division 39 Members: South America, Africa, Asia, Middle East
Add $40 to my registration fee for a one-year Division 39 Membership
I am a Student, add $15 to my registration fee for a one-year Division 39 Membership
I am an ECP, add $30 to my registration fee for a one-year Division 39 Membership
$215

Affect Regulation Theory $60
Witness to Genocide $60
On Dreams and Dreaming $60
I'm not registering for a Master Class during this time period.
Transference-Focused Psychotherapy (TFP) 3 CE Credits $60
The Psychotherapist's Subjectivity $60
I'm not registering for a Master Class during this time period.
Striking When the Iron's Cold? (ECP Master Class) $40
I'm not registering for a Master Class during this time period.

APF Division 39 Fund: I would like to make a tax deductible contribution of $

Total payment due: $

(Registrations will not be processed unless accompanied by full payment.)

To register by mail, send this form to:
Natalie Shear Associates, Div39 Conference Coordinators
1000 Vermont Avenue NW - Third Floor
Washington, DC 20005
Fax forms to 202-446-2965

Refund Policy: Refund requests must be received in writing prior to midnight (EDT) April 1, 2017. Fees will be refunded less a $75 processing fee. There will be no refunds made after April 1, 2017. Please email refund requests to Div39nyc17@natalieshear.com or fax to 202-446-2965

There is a $25 processing fee for credit cards and checks that are declined.

Payment Information (These are the only accepted methods of payment.)
Visa, MasterCard, Amex or Check (Made payable to Division 39, APA) 

Card Number:                                                                        Expiration Date (mm/yy):
- - -                    

For Registration Questions: (800)833-1354 x4 or by email HankLewis@natalieshear.com

For all other Questions: email Div39nyc17@natalieshear.com or (800)833-1354.

Note: Registrations postmarked after April 12, 2017 will be returned.
DO NOT mail or fax registrations after that date. You can register onsite at the Sheraton beginning Wednesday, April 26.

There will be an additional $55 added to the above fee schedule for all onsite registrations.

After you submit your registration form with payment information, you will receive an email reprising and confirming receipt of that form. After your payment is processed, you will receive an email confirming your registration. Note: All confirmations are sent via email.