Tampa Bay Psychoanalytic Society
Scientific Meeting REGISTRATION Form

Two easy registration methods! You may register by :

Online Registration
1.Type your information in the spaces provided below
2. Click on the "Submit" button at the bottom of the form
3. Mail check for payment of fees to address noted at the bottom of the form
or
Mail Registration
1. Print the completed form
2. Mail the form along with your payment to the address noted at the bottom of  page.

THIS PAGE IS CURRENTLY NOT IN SERVICE.  UNDER CONSTRUCTION.  EMAIL drbob@drbobtampa.com if you need information.

First Name

 Last Name
Degree
 License #/Discipline
Address
City
State
 Zip Code
Email
Contact Phone
Additional
Comments

Please indicate which meeting(s) you would like to register for:
(check all that apply)

September 11, 2010      Sandy Shapiro, MD   “The Evolution of Contemporary Psychoanalysis”

October 9, 2010     Hazel Ipp, PhD “Nell: A Bridge to the Amputated Self - The Impact of Immigration on the Continuity and Discontinuity of Self”

November 13, 2010      Peter Buirski, PhD  “Two Approaches to Psychotherapy: Traditional Psychodynamic Psychotherapy and Intersubjective Oriented Psychotherapy, With an Illustrative Case”

No Meeting in December           

January 15, 2011    Alan Kindler, PhD “TBA”

February 12, 2011    Malcolm Slavin, PhD  “Why the Analyst Needs to Change”

March 19, 2011     Richard Geist, PhD  “TBA”       

April 9, 2011     Donna Orange, PhD  “TBA”

Continuing Education Credit Requested?

Septemeber

October
November
None
January
February
March
April
Yes