REGISTRATION FORM
34th Annual Meeting
American Academy of Clinical Psychiatrists
“THE USE OF NEW TECHNOLOGIES IN PSYCHIATRIC PRACTICE”
Friday - Sunday, March 14 – 16, 2008
PLEASE PRINT CLEARLY

Name _______________________________________________
Address _____________________________________________
City _________________________State___ ZIP ____________
Business Phone ______________FAX__________________

E-mail:___________________________________________
Academic Degree _______ Specialty/Subspecialty ___________

FEES:
AACP Members:
Pre-Registration: $265
On-Site: $315

Non-Members:
Pre-Registration: $345
On-Site: $395

Psychiatric Residents Pre-Registration $170
On-Site:                                            $220

TOTAL                                                  $____

AACP ANNUAL RECEPTION (Included) Saturday, March 15, 2008
Please indicate whether you plan to attend:
(   )  Yes – Total in Attendance _____
(   )  No

METHOD OF PAYMENT
(   ) I enclose a check made payable to AACP
(   ) Charge to my:   (   ) VISA    (   ) Mastercard  (  ) American Express
Card Number ________________________
Exp. Date ___________________________
Cardholder Name _____________________
Signature ____________________________

For further information, please contact:
Beverly Davidson
American Academy of Clinical Psychiatrists
144 Georgetown Drive
Glastonbury, CT 06033
860-635-5533 office
860-613-1650 fax
aacp@cox.net
________________________________________________________