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Course Registration Form | Print |
MPC  Course Registration Form

Name: ____________________________________________

Address:__________________________________________

  _________________________________________________

  _________________________________________________

Occupation:_______________________________________

Phone:____________________________________________

E-mail:____________________________________________


MPC Member Status:  

Member _____      Request for membership  _____     Candidate  _____


List courses by name and term:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

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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.