International Society of Prenatal and

Perinatal Psychology and Medicine (ISPPM)

International ISPPM Workshop

25. – 27. September 2009 at Heidelberg, Germany

Past, Present and Future of Pre- and Perinatal
Psychology and Medicine

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

ISPPM Non-members		€ 200,--
ISPPM members		€ 180,--
Students, pupils, retired persons		€ 120,--
Workshop with David Chamberlain on Sept. 25, 2009		€ 120,--
Workshop with David Chamberlain (reduced for congress member)		€ 95,--
Workshop with Phyllis Klaus on Sept. 24, 2009		€ 120,--
Workshop with Phyllis Klaus (reduced for congress member)		€ 95,--

The registration fee includes:

The entrance fee for scientific sessions, workshops and the exhibition area, a congress pass, coffee breaks (incl. food/drink).
Lunch and catering during the workshop are not included and must be payed separately.

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 2009".

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 September 1, 2009. 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 September 20, 2009. Refunds will be made after the end of the congress.

ISPPM-Secretary

c/o Axel Bischoff

Friedhofweg 8, D - 69118 Heidelberg, Germany

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

E-mail: <secretary@isppm.de>

Last updated on: July 14, 2009 by A.Bischoff