INTERNATIONAL PSYCHOHISTORICAL ASSOCIATION
PO BOX 314
NY, NY 10024
 

ADVANCE REGISTRATION FORM
33rd ANNUAL IPA CONVENTION
June 9-11, 2010

Our 2010 Convention will feature diverse and exciting psychohistorical presentations on a wide variety of topics. We are working hard to make this our best Convention yet. Register early so that you can be part of this important and exciting conference. We look forward to seeing you.
 
RATES for the Convention are as Follows : -
  MEMBERS NON-MEMBERS STUDENTS
Three day rate $160 $190 FREE
Single day rate
(no discount)		 $90 $120 FREE
TO BE ELIGIBLE FOR FREE RATE PLEASE INCLUDE COPY OF CURRENT STUDENT ID CARD
Make checks out to IPA, payable in US dollars
 
I want to join IPA. My dues of $40 are also enclosed _______
I have enclosed $40 to renew my IPA membership _______
I wish to be a lifetime member & have enclosed $1000 _______
(PLEASE NOTE:- Dues are in addition to your Convention payment)
 
Send your checks and completed registration form to:-
Henry Lawton, IPA Secretary
266 Monroe Ave
Wyckoff, NJ 07481-1915
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NAME: ________________________________________________________
ADDRESS: ________________________________________________________
CITY: ______________________________ STATE: __________ ZIP: _________
PHONE [Home]: _____________________ [Office]:
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AFFILIATION (if any): _______________________________________________
 
To submit a Convention presentation proposal contact Dr. Allan Mohl by E-mail at Mo9al@aol.com
 
THANK YOU FOR YOUR INTEREST AND SUPPORT