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Registration and Payment Form

ICP 61st Convention

Toronto, Ontario Canada

August 11-14, 2003

 - Registration should be accompanied by payment, a prerequisite for abstract consideration.The only credit card accepted  is VISA.  It is highly recommended that participants residing in North America and where possible, use Checks or Money Orders for payment.

- A form is good for one person, please photocopy if needed

- Included in fees:  program, souvenir conference bag, opening reception, 2 lunches, 4 coffee and snacks, plus all taxes (reception August 12, scientific program, 13, 14)

- ICP souvenir T-shirts must be ordered in advance: circle size:  S, M, L, XL, XXL

- Continuing Education Workshop on August 11 and 12, 2003, in next issue

- This form is also available at our website:  http://www.unipod.it.ammi/news/ICP.htm

- Send completed registration along with payment (in US dollars) to:

Dr. Antoinette Thomas, 100 de Normandie, St. Lambert, Quebec, J4S-1T4, Canada. Fax: (450) 466-9459

PARTICIPANT REGISTRATION (please print clearly)

Title: Prof.            Dr.            Ms.            Mrs.            Mr.

Name on badge:  First __________________________ Last _______________________________

 _____________________________________________Tel._______________________________

Fax_____________________________Email_____________________________________________

Do you prefer vegetarian lunches:  August 13 _________and August 14___________

Will you be a guest at the main hotel (the Colony)? Yes_____ No______ If yes, how many nights? ____________ Are you sharing room with another ICP member? Yes_______ No _____

 

ACCOMPANYING PERSON REGISTRATION

 Name on badge:    First ____________________________________ Last __________________________

Do you prefer vegetarian lunches:  August 13 _________and August 14___________

_____________________________________________________________________________________

Payment Details :  * *The only credit card accepted  is VISA.  It is highly recommended that participants residing in North America and where possible, use Checks or Money Orders for payment.         

Check or Money Order in US dollars made payable to:  International Council of Psychologists

____ VISA Credit Card # ___________________________  Expiry Date ________________ (MM/YY)

(Please print the following information)

Name of Card Holder as appears on card:  ________________________________________

Exact Billing Address for this Credit Card _________________________________________________________________________________________

Please use Electronic/direct transfer only if necessary (It is most costly to ICP.):

______ Bank Electronic Transfer to:

ICP-Antoinette Thomas

US Account 4002762-TR 00541
Royal Bank of Canada # 003
7250 Taschereau, Brossard

 

All amounts in US dollars Fees April 21 or after
ICP Member (Countries A & B)  $200. $220.
Non-member (Countries A & B) $220. $240.
ICP Member (Country C) $100. $120.
Non-member (Country C) $110. $130.
Accompanying person $150. $170.
Full-time student  $100 $120.
T-shirt $10. $10.
Banquet (August 14) $45. $45.
TOTAL AMOUNT US$. _______ US$ ________
(Students, please forward full-time study document)

 

        Received Cancellation Notification

Date of cancellation Prior to August 11, 2003  Percent of Refund
120 days or more   by April 13       100 %

90-119 days     

by May 13 90 %  
60-89 Days  by June 12  75 %  
30-59 days   by July 12      50 %  
Less than 30 days   July 13 or after no refund