Content provided by the Michigan Psychoanalytic Council (MPCPSA.ORG).
Copyright 2004-2005 Michigan Psychoanalytic Council. All Rights Reserved.


Print out the form below (one for each course),
and return it with the course fee 

Jean Wixom, Ph.D., 332 East Washington, Suite B, Ann Arbor, Michigan, 48104, Email: .  Phone: (734) 662-7513.  Please include the appropriate fee and make checks payable to Michigan Psychoanalytic Council. 


Course Title(s): _______________________________________________________________   Fee(s): ____________


Name: _______________________________________________________ E-mail: _____________________________


Address: _________________________________________________________Phone: _________________________


Membership status in MPC   ___ Member   ____ Request for membership material


Confirmation of registration and forthcoming details regarding classes will be forwarded by e-mail if possible.