Registration Form - The Chicago School of Professional Psychology

ICP 2010 CONVENTION REGISTRATION
“Psychological Values Around the World”
President-Elect and Program Chair: Dr. Ludwig Lowenstein, England
Local Arrangements Chair Dr. Donna Goetz; with Dr. Neal Rubin, Dr. Mike Atella, Dr. Stewart Cooper, Dr.
Bob Clark, and Graduate Student Erica Greene
Registration Form
Complete all of the following information
Email Completed information Form to : ICP Secretariat Office at The Chicago School
SMachizawa@THECHICAGOSCHOOL.EDU
Pay Registration Fee via PayPal on Website. http://www. icpweb.org
OR MAIL CHECK IN USA FUNDS TO ICP %Treasurer Gerald Gamache
8 Althea Street, ST AUGUSTINE, FL32084, USA
Dr. Prof. Ms Mr. Mrs. Others
Last Name [Family Name]:
___________________________
Given Names [First and Middle Name or Initial]: _____________________________
Work: Department/Organization:_________________________________________
Preferred address for correspondence: Office Address
Address: Street:
City:
State:
Country:
Office Phone/Fax:
Email:
Preferred Name on Badge:
Home Address
Please provide your country code for phone + fax.
Special dietary/disability requirements (Please specify)
Home Phone:
Zip:
Registration Fee is payable AT ICPWEB.ORG VIA PayPal (Master Card or Visa). Checks on USA bank accounts
should be made payable to the ICP, marked as 68 th Conference Registration Fee Country { A,B,C, Student,
Professional,Other} and mailed to ICP Treasurer. Gerald Gamache, address above.
Registration Fees:
Member Category
Member Countries*
Category A
Category B
Category C
Registration
Up to June 15
350.00
250.00
200.00
Registration
After June 15
375.00
275.00
200.00
On site
Registration
400.00
300.00
200.00
Late
DUES FOR
2010
125.00
85.00
65.00

*Students:
Member
Non-Member
Non Members
Professional
75.00 75.00
75.00
50.00
100.00 100.00
125.00
50.00
400.00 400.00 450.00 See Country
Dues
Person-Accompanying 100.00 100.00 100.00
• Country of residence determines registration fees above:
Category A Countries:
Australia, Austria, Bahrain, Belgium, Brunei, Canada, Denmark, Finland, France, Germany,
Great Britain, Greece, Hong Kong, Iceland, Ireland, Israel, Italy, Japan, Kuwait, Luxembourg,
Netherlands, New Zealand, Norway, Portugal, Qatar, Saudi Arabia, Singapore, Spain, Sweden,
Switzerland, Taiwan, United Arab Emirates, USA.
Category B Countries:
Antigua & Bermuda, Argentina, Bahamas, Barbados, Brazil, China, Croatia, Cyprus, Czech
Republic, Iran, Korea, Malaysia, Malta, Mexico, Oman, Poland, Seychelles, Slovakia, Slovenia,
South Africa, Suriname, Turkey, Venezuela, Yemen.
Category C Countries: All other countries.
• Student status statement from the university department is required
Registration includes:
• Full access to All Congress Scientific Sessions
• Congress Badge
• Book of program/Abstracts
• Opening Ceremony & Welcome Reception [cash bar]
Registration for accompanying persons includes:
• Admittance to the Opening Ceremony & Welcome Reception
• Special ICP Prices for Organized tours & dinners
• Full access to All Congress Scientific Sessions
SUMMARY OF PAYMENTS SUBMITTED FOR SCIENTIFIC PROGRAM, WORKSHOPS,
AND SOCIAL EVENTS:
US Dollars
SCIENTIFIC PROGRAM
REGISTRATION ICP Membership Status: [CIRCLE ONE] A B C Student
Professional Accompany
Accompanying Person(s)
REGISTRATION
Name[s]:
SOCIAL EVENTS: AUGUST 4 AUGUST 5 AUGUST 6 AUGUST 7
LUNCH 25.00 25.00 25.00 25.00
BANQUET 50.00
CONTINUING EDUCATION [pay onsite]
1. APA CE $15 per Hour
2. ICP World Continuing
Education $10 per Hour
Total Payment Submitted: $
CHECK ONE
PAYPAL
CHECK

ALL TOURS AND SIGHT SEEING ARE BY INDIVIDUAL ARRANGEMENT
Hotel: HOLIDAY INN CHICAGO MART PLAZA
350 West Mart Center Drive
Chicago, IL USA 60654
Senior Hotel Representative: Michele Hill-Pondexter, CHSP USA 011 312.529.1113
FAX:011 312.836.0007 email: mhpondexter@martplaza.com
Hotel Room Reservation: Room Rate $139 plus 15.4% taxes [$160.41]
Please request the special rate for International Council of Psychology/The Chicago School
Offered from Sunday August1 through August 9
AT A GLANCE
CALENDAR. ICP 68 TH CONFERENCE
CHICAGO, ILLINOIS USA
August 3 rd .
Board Workshop. 09:00 to 17:00 hrs. Holiday Inn Chicago Mart Plaza
CE Work shops. 9:00 to 17:00 hrs.. To Be Announced
Sight Seeing Options. To Be Announced
August 4th.
Outgoing Board Business Meeting. 9:00-12:00hrs. Holiday Inn Chicago Mart Plaza
CE Work shops. 9:00 to 17:00 hrs. To Be Announced
Sight Seeing Options. To Be Announced
OPENING SESSION AND RECEPTION. ICP 68 th
18:00 to 21:00 hrs. Holiday Inn Chicago Mart Plaza .
August 5 & 6.
Scientific Program Sessions. THE CHICAGO SCHOOL OF PROFESSIONAL
PSYCHOLOGY, THE CHICAGO SCHOOL CAMPUS
August 7th.
Outgoing Board Business Meeting. 9:00-12:00hrs. Holiday Inn Chicago Mart Plaza
CE Work shops. 9:00 to 17:00 hrs. To Be Announced
Sight Seeing Options. To Be Announced