Or Register Below by sending the current equivalent of 350 euros, in U.S. dollars, with this form to the address below. Full-time students pay 100 euros if they include a copy of their student ID card with their registration.
Inviting two additional registrants allows a fee rebate of 50 euros.
Registrants must provide the name of sponsor here
_________________________________________
Wiring to the meeting's account, the Swift number
(used in europe) is MANTUS33. The Routing number is 022000046.
The bank is M&T. Its number is 052000113.
Our account number is 912551681 and the account is
"Ann-Louise Silver MD - Clinical Sándor Ferenczi Conference"
The bank's phone number is 410-740-1512
Name (and degree)_____________________________
Address ____________________________________
___________________________________________
City _______________________________________
State ____________________ Zip _______________
Country ____________________________________
Telephone number ____________________________
E-mail ______________________________________
Send to: Clinical Sándor Ferenczi Conference,
c/o Ann-Louise S. Silver, M.D. 4966 Reedy Brook Lane;
Columbia, MD 21044-1514, USA. |
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