Registration form and NEW LINK to register online

Now you can register for the current lecture online at http://icpnyc.org/sicp/

Name                                                     Email                                   ___add me to your list  

Phone                                                    For current trainees: Affiliation

Please circle item and fee

	Regular	Current trainee	SICP member
Join SICP	$50	$25
All 4 lectures	$90	$50	$70
12/4    Frank Lachmann	$25	$15	$20
1/29    Steven Knoblauch	$25	$15	$20
3/11    Steven Kuchuck	$25	$15	$20
5/6      Jeremy Safran	$25	$15	$20
CEU fee per lecture (x___ )	$15	$15	$15
Total	.	.

Please mail this with your payment to the registrar, Barbara Bolas, PhD at 3343 Crescent Street, Apt 3J, Astoria, NY 11106 or leave it with your payment in her ICP mailbox. With questions, email sicp.lectures.barbara@gmail.com

SICP membership runs from 9/1/15-8/31/16. CEUs are under the auspices of The Institute for Contemporary Psychotherapy

Payment must be received 1 week before the lecture. After that time, please email sicp.lectures.barbara@gmail.com and we will reserve your seat and add you to the “pay at the door” list. There is a $10 charge for payment at the door. Refunds are available until 1 week before the event.