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.
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 8, 2007        Peter Rudnytsky, PhD

October 13, 2007          Elizabeth Reese, Lcsw; Mary Fernandez, LCSW

November 4, 2007        Barry Cohen, Esq, Anthony Marchese, Esq., Linda Gunsberg, PhD

December 1, 2007        Anna Ornstein, MD, Paul Ornstein, MD

January 5, 2008            Frank Summer, PhD

February 9, 2008         Kelly Novick, PhD, Jack Novick, PhD

March 15, 2008            Idlewild Film Presentation and Discussion

April 26, 2008                 Nancy Goodman, PhD


Continuing Education Credit Requested?
Yes