REGISTRATION FORM

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Yes         No

Yes         No

Yes         No




Postmarked or electronically submitted by 4/06/2018 On Site
Member $445 $500
Non Member
Please add $95 to my registration fee for a Division 39 Membership, and charge me the member rate.
$525 $580
Student Member $70 $95
Student Non Member
$25 of all student non-member registrations will be applied to a one-year Division 39 Membership
$95 $120
ECP Member (Date of Doctoral Degree April 2008 or later) $170 $220
ECP Non Member (Date of Doctoral Degree April 2008 or later)
Please use $50 of my registration fee towards Division 39 Membership
$200 $250
Institute Candidate member (Enrolled in first 5 yrs of curriculum only) $170 $225
Institute Candidate Non Member (Enrolled in first 5 yrs of curriculum only)
Please use $95 of my registration fee towards Division 39 Membership
$230 $285

Foreign Affiliates postmarked or electronically submitted by 4/06/2018 On Site
Current Division 39 Members: Canada or Western Europe or Australia or New Zealand or Japan $365 $415
Current Division 39 Members Other Countries: South America or Africa or Asia or Middle East $200 $255
Non-Division 39 Members: Canada or Western Europe or Australia or New Zealand or 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
$390 $440
Non-Division 39 Members: South America or Africa or Asia or 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
$210 $265


Excursion to the Whitney Plantation ($100)
      Fully Booked,- No Space Available.
      (Limited to 41 Attendees;-Lunch and Transportation included in cost)


Relational Freedom: Emergent Properties of the Interpersonal Field ($80)
      Speaker: Donnel Stern, PhD
      (Click here to read a description of the session)

Understanding Personality Patterns in Psychotherapy ($80)
      Speakers: Nancy McWilliams, PhD and Jonathan Shedler, PhD
      (Click here to read a description of the session)

Couples on the Couch: Narcissistic Relating and the Fate of Curiosity ($80)
      Speakers: Shelley Nathans, PhD and Milton Schaefer, PhD
      (Click here to read a description of the session)

Ghostbusting in Parent-Child Work: Framed with Mentalization and the PDM-2 ($80)
      Speakers: Larry Rosenberg, PhD and Laurel Silber, PsyD
      (Click here to read a description of the session)

I'm not registering for a session during the afternoon.

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

TOTAL PAYMENT DUE: $

Check here if you’d like to have an abbreviated paper copy of the conference program mailed to you. This will be available in January 2018. The comprehensive program listing will be available online, at the same time, at http://division39springmeeting.org.

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

To Register By Mail,
Complete this form, Print it, and send it and any required documentation, with your credit card information or check (payable to Division 39 - APA) to:

Natalie Shear Associates,
Div39 Conference Coordinators
1000 Vermont Avenue NW - Third Floor
Washington, DC 20005

To Register By Fax,
You may submit your registration form by Fax, only if you are paying by credit card. Fax your completed forms and any required documentation to 202-446-2965.

Refund Policy: Refund requests must be received in writing prior to midnight (EDT) March 27, 2018. Fees will be refunded less a $75 processing fee. There will be no refunds made after that date. Please email refund requests to Div39nola@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 or by email HankLewis@natalieshear.com

For all other Questions: email Div39nola@natalieshear.com or (800)833-1354.

Note: Registrations postmarked after April 6, 2018 will not be processed.
After April 6, you can register onsite at the Intercontinental Hotel beginning Wednesday, April 18 at 11am.

When this form is fully/correctly completed and “submitted” on-line, the screen changes to a message thanking you for submitting the registration.

When the credit card associated with the registration has been successfully charged, a formal confirmation of registration will be emailed to you.