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 to:

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.