| DSPP Fall Workshop 2002 Registration Form
Robert D. Hinshelwood,
Ph.D.
"Reflective Space"
Saturday
October 12, 2002
________________________________Degree_______
Name |
___________________________________________
Address |
| ___________________________________________ |
___________________________________________ |
Office____________________Home________________
Phone |
| Membership Status
|
Fees
|
| ( ) Nonmember |
$110.00 |
| ( )
DSPP Member |
$100.00 |
| ( )
Associate Member |
$80.00 |
(
) Student |
$35.00 |
| (
) Late Fee
(After Oct 4 & on site) |
$10.00 |
| Total:: |
_______ |
| Please make check or money order payable
to DSPP
|
Please send
completed registration and payment to:
DSPP Fall Workshop
4516 Lovers Lane # 446
Dallas, Texas 75225
*Continental
breakfast and Lunch included*
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