AAP I&C Registration Form

2010 AAP I&C Registration
Generativity: Energizing the
Life of the Therapist
November 3-7, 2010
Mariott Inner Harbor
Baltimore, MD
Registration Form

Complete registration form below to register online with a credit card. Check payments receive a discount of $10 off for full registration, and $5 off for single day registrations. If you would like to pay by check, please click here to download the brochure with a mail-in registration form.

Attendee information*

First Name: Last Name: First Name for Badge:

Street Address:

City: State: ZIP:

Phone Work: Phone Home:

FAX: E-mail (for confirmation):

If your are not an AAP member, how did you here about the conference?

Other web site If so, which web site

Postcard

Friend/colleague

Mailed brochure

Other

AAP web site

If someone encouraged you to attend, please write their name here
(only one name)

CONFERENCE FEES*
	Prior to 8/1	Prior to 9/15	After 9/15
Member	$435	$455	$475
Non-Member	$455	$475	$500
Student	$215	$225	$235
Single Day(s)/ $165 per day number of Single days attending. Select days attending: Thursday Friday Saturday

Optional Fees *
$100 CME Processing Fee $45 CE Processing Fee $75* Wednesday Evening Buffet $65 Saturday Night Banquet & Dance: Fish Beef Chicken Vegetarian * Full registrations include Wednesday Buffet.


Workshop Selections*
Please indicate your 1st, 2nd, and 3rd choices by writing the workshop number in the space provided. For multi-session workshops, repeat the workshop number in the spaces on both days.
Thursday Afternoon		Enter workshop # 1st 2nd 3rd
Friday Afternoon		Enter workshop # 1st 2nd 3rd
Saturday Morning		Enter workshop # 1st 2nd 3rd
Saturday Afternoon		Enter workshop # 1st 2nd 3rd
All workshop requests received by September 15 will be assigned beginning September 16. After that, requests will be assigned in the order received.

To clear the form select OR To continue

For information call: 919-779-5051