JAP  CONFERENCE   REGISTRATION

Jungian Analytic Training for the 21st Century
Friday 16th June to Sunday 18th June 2006
McGill University, New Residence Hall, Montreal 

To register please print this page, complete the form, and mail it to the Journal’s address in London: 
Journal of Analytical Psychology Conference
1 Daleham Gardens, London NW3 5BY
[Payment in full must be included with the registration]

I would like to pay by :
cheque US$ / £ (payable to the Journal of Analytical Psychology)
credit/debit card
     Visa
     Mastercard
     Maestro
     American Express

Card Number ___________________________________

Card valid from  _________    Card expiry date: ______
Issue Number:   _________    Date:  _______________

Name  ___________________________________________

Address
_________________________________________________

Post Code   ____________________
Telephone  __________________________________
Fax    ______________________________________
Email   ______________________________________

Signature    _______________________________________

Profession
analytical psychologist
psychoanalyst
trainee in analytical psychology/psychoanalysis (please specify)
mental health practitioner or student (please specify)
other (please specify)

Fee enclosed:
Single:
£380 pre-16th April 2006 (US$670)
£410 post-15th April 2006 (US$720)
Double/Twin:
£640 pre-16th April 2006 (US$1080)
£690 post 15th April 2006 (US$1200)
Extra night:
£60/US$105 (single)
£85/US$150 (double/twin)

Total enclosed $/£  __________

CANCELLATIONS
Cancellations will be accepted up to 15th April 2006 with a refund less a US $105/£60 administrative fee. No refunds will be made after that date.