INTERNATIONAL FORUM FOR PSYCHOANALYTIC EDUCATION

2015 Conference Registration Form

November 5 - 7, 2015

Sheraton Society Hill Hotel, One Dock Street, Philadelphia, PA 19106

Advance registration is advised. Registration fee is for the conference only. No day or partial rates available.

: $345 Members $395 Non-members

Full-time student (Graduate or Undergraduate program only): $110

(Does not apply to psychoanalytic candidates.)

IFPE 2015 Annual membership dues: Individual: $110, Contributing: $200, Sustaining: $500,

Full-time Student: $55. Dues are for the calendar year. IFPE’s criterion for membership is a self-declared

interest in psychoanalysis. Please visit www.IFPE.org to see IFPE’s membership benefits.

Name: ______

Address: ______

City/State/Zip: ______

Telephone: ______Email: ______

Sign up for IFPE’s Special Events:

Thursday Evening, November 5th: Ticket to bring a Guest to the No-Host Cocktail Reception:

Complimentary admission if you are wearing the IFPE name badge from your registration packet. You

may bring guests who are non-conference registrants for a fee: # of non-registered guests ____ x $25 = $______

Friday Evening, November 6th, 5:30 – 9:00 p.m.: Visit the legendary Barnes Foundation Art Collection–

among the world's finest collections in its architecturally spectacular new building. Price of $50 covers

admission to the museum and round trip transportation, no-host “First Friday” reception available at the

Museum.** Space is limited; advance registration is strongly advised.

**Must pre-register to attend. # of persons _____ x $50 = $______

Saturday Evening, November 7th: Awards Dinner at $90 per person.** Space is limited.

**Must pre-register to attend. # of persons _____ x $90 = $______

Please specify choice of entrée for Awards Dinner for each person registering:

[ ] Grilled farm-raised Cobia over toasted Israeli couscous, fennel-roasted tomato and basil relish

[ ] Breast of Chicken with Prosciutto Ham, Fontina cheese, over toasted Israeli couscous with a balsamic reduction

[ ] (Vegetarian) Wild Mushroom in Puff Pastry accompanied by white bean puree with roasted peppers

Registration amount included $______

Membership amount included (if applicable) $______

Donation to IFPE's non-profit 501(c)(3) General Fund $______

TOTAL ENCLOSED $______

REGISTRATION AND PAYMENT BY CREDIT CARD IS AVAILABLE AT: www.IFPE.org

For U.S. residents, payment by check (made out to “IFPE”) is preferred and much appreciated.

Mail registration form with payment to: IFPE, P.O. Box 961, Culver City, CA 90232-0961

Please allow 2 weeks for confirmation receipt.

Refund Policy: Request for refund must be made in writing and received before October 1, 2015;

a 25% administrative fee will be charged. No refunds after October 1, 2015.

Registration fees are non-refundable for those scheduled to present at the conference.

Questions? Call (310) 694-3463 or email