NZIPP Reading Group
Please complete the form below to register
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
Will you be attending online?
yes
E-mail for Zoom link:
example@example.com
Please Pay to NZIPP Bank Account: 38-9016-0052471-00
Specify: your Name, Semester and Event attending
Reading Group NZ$250
5 motlhly meetings of 2 hours each, for 1 Semester
How did you hear about these events?
Web Site
Friend/Colleague
Social Media (i.e. Facebook, Instagra)
Email
Other
Submit
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