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October 28th and 29th, 2011
Name  * required
Street Address  * required
City  * required
State  * required
Zipcode                                * required
Country  * required
Email  * required
Phone  * required
Fax
ICSPP Conference Fee Schedule & Payment Option
Fri or Sat 1 person x $140.00 per day Fri Sat Both $
$50 Half-day without lunch Yes No $
$75 Half-day with lunch Yes No $
Add: $50 Welcome Dinner Fri Night Yes No $
Add $25:Continuing Education Certificate Yes No $
Less $25per day:ICSPP Member/Student Yes No $
If registering for both days $20 discount Yes No $
TOTAL AUTHORIZED AMOUNT $
Payment Through Check Credit Card
First-Time Attender Yes
Questions & Hardship?: Call Dr. Michael Gilbert @ 315-382-0541 or email him at mgilbert@iacaf.org.
When you use the 800 number to make hotel reservations, give them our conference code - "ICS".
If you are registering a group of 3 or more persons, contact Dr. Gilbert for group discount.
Fax Registration: 920-694-0999
Email Registration: mgilbert@iacaf.org
Mail Registration To: PO BOX 281, Jamesville, NY 13078
International Society for Ethical Psychology and Psychiatry www.psychintegrity.org
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