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MPC Course Registration Form
Name: ____________________________________________
Address:__________________________________________
_________________________________________________
_________________________________________________
Occupation:_______________________________________
Phone:____________________________________________
E-mail:____________________________________________
MPC Member Status:
Member _____ Request for membership _____ Candidate _____
List courses by name and term:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Send form with a check payable to 'Michigan Psychoanalytic Council' to:
Reena Liberman, M.S., Registrar
1207 Packard Street
Ann Arbor, Michigan 48104
734.741.1655
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Full payment is due by the second class meeting unless prior arrangements have been made with the Registrar.
Acceptance of students for specific courses will be based on previous education and the decision of the course instructor and the Training and Certification Committee.
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