International Society of Prenatal and

Perinatal Psychology and Medicine (ISPPM)

XVI.-th International ISPPM Congress

Heidelberg, 2. – 5. June 2005

The Anthropology and Psychology of Pregnancy and Birth

Registration form

Participants are kindly requested to register for the congress using this registration form. All three parts of the registration form must be completed. Please submit the completed form to the ISPPM-Secretariat by pressing the send button, or print it out and send it via fax or post.

1) Participant

Title*
Title
First name*
Last name*
Street, no.*
Post code, City
Country*
Phone
Fax
e-mail*

Notes:

2) Registration Fees

	Paid before 1. May 2005		Paid after 1. May 2005
ISPPM Non-members		€ 400,--		€ 450,--
ISPPM members		€ 340,--		€ 390,--
Students, trainee midwives		€ 200,--		€ 250,--
Speakers		€ 150,--		€ 150,--

The registration fee includes:

The entrance fee for scientific sessions, workshops and the exhibition area, a congress pass, lunch on Friday and Saturday and coffee breaks (incl. food/drink).

3 ) Methods of payment

Payment by credit card

Mastercard Visa	(no other credit cards will be accepted)
Cardholder's name
Credit card number
CVV / CVC - Code
Expiry date (MM/YY)
Name / signature

CVV2 (VISA) = card verification value
CVC2 (MasterCard) = card verification code

This number is printed in the signature box on the reverse of your credit card. The last three digits after the card number is the card varifivation value/code.

Payment by bank transfer

Direct bank transfer

Transfer to the ISPPM's bank account - Sparkasse Heidelberg,
account no. 42 46 322, bank code: 672 500 20, payment reference "Congress 2005".

NB: If paying by direct bank transfer, please add EUR 15,-- to cover bank charges.

For payments from abroad as an EU-standard-bank transfer:

IBAN: DE57 6725 0020 0004 2463 22

SWIFT-BIC: SOLADES 1 HDB

Name of wire transfer
Date of wire transfer

You will be invoiced for any outstanding balances

Please before you send, check this registration form.

All three parts of the registration form must be completed, incomplete registrations will not accepted.

Registration

* = Mandatory field, please fill out, to register!

Cancellations and refunds

Cancellations should be made in writing to the ISPPM-Secretariat. A full refund will be granted (less a 20% administrative charge) if cancellations are received before 15 May 2005. Cancellations received after this date will not be eligible for a refund. If you are unable to attend, registrations may be transferred to another name, please inform the ISPPM-Secretariat by 30 May 2005. Refunds will be made after the end of the congress.

ISPPM-Secretary

A. & J. Bischoff

Friedhofweg 8, D - 69118 Heidelberg, Germany

Telefon: +49 (0)6221 892729 Fax: +49 (0)6221 892730

E-mail: <secretary@isppm.de>

Last updated on: 03. März 2005 by A.Bischoff