Registration
Complete form below to signup for: Public Lecture on Saturday 30/09/23 and/or Workshop on Sunday 1/10/23.
Name
First Name
Last Name
E-mail
example@example.com
Profession
Please Select
Psychoanalyst
Psychiatrist
Clinical Psychologist
Psychologist
Counselling Psychologist
Psychotherapist
Psychoanalytic Psychotherapist
Social Worker
Mental Health Nurse
Counsellor
Other
Please choose your profession
Membership/Affiliation
i.e. NZIPP
Full time Student (please specify):
University, Training Institute, ...
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Format: (+00) .
Registration:
prev
next
( X )
Public Lecture
$
120.00
Workshop
$
250.00
Public Lecture and Workshop
$
330.00
Public Lecture Full Time Student
$
60.00
Workshop Full Time Student
$
125.00
Public Lecture and Workshop Full Time Student
$
165.00
Will you be attending online?
yes
E-mail for Zoom link:
example@example.com
Please Pay to NZIPP Bank Account: 38-9016-0052471-00 by 20 September
Incl. Name and Event/s attending
How did you hear about these events?
Web Site
Friend/Colleague
Social Media (i.e. Facebook)
Email
Other
Submit
Should be Empty: