Pre-Congress Registration Form

Important! Please print this form out, fill it out accordingly, and mail it with a check or money order to the specified address! You can print this form by clicking on the Print Icon Button at the top of your browser.

**FEES**
Conference Registration
Basic Registration Fee (before March 30, 1997): $130.00	_________
Late Registration Fee (after March 30): $150.00	_________
Basic Registration Fee for Full-time Student: $50.00 (Include Advisor Statement of full-time status)	_________
Late Registration Fee for Full-time Student: $70.00 (Include Advisor Statement of full-time status)	_________
Gala Dinner on Saturday Evening, July 12, 1997 Write in number of tickets _____ at $40 each:	_________
Pre-conference workshops (July 8, 1997)
___ Fay Fransella - 8:30 AM to 12:30 PM: $60.00	_________
___ Michael Mahoney - 8:30 AM to 12:30 PM: $60.00	_________
___ Hubert J. M. Hermans - 2 PM to 6 PM: $60.00	_________
___ Larry Leitner - 2 PM to 6 PM: $60.00	_________
___ REGISTER FOR TWO WORKSHOPS: $95.00	_________

TOTAL:	_________
(Please enclose a check or money order in U.S. Dollars payable to PCP 12th Congress)

Name: _________________________________________________________
Mailing Address: _________________________________________________________
City/State Zip/Country: _________________________________________________________
Telephone: __________________	Facsimile: __________________	E-mail: __________________

Mail this registration form and a check or money order to:
Jerald Forster, Ph.D.,
University of Washington
Box 353600
Seattle, WA 98195-3600
USA