Registration Form
of the XIIth International Encounter of The Freudian Field


Personal information

Name 
First Name 
Address 
Zip code  Phone 
City  Fax 
Country  E-mail 

Inscription Prices

160 €
80 €    students under 26 with proof of student status

Modes of inscription and payment

Payment by credit card 
Payment by cheque (Only Banque Française)


 
In Case of technical difficulty in validating the form, complete and print this page (using print function of your browser) and fax it to +33 (0)1 40 09 04 07 or mail it to: Champ freudien, c/o Patricia Johansson-Rosen, 75-77, rue des Grands Champs, 75020 Paris.
E-mail: p.johansson-rosen@wanadoo.fr
 
A registration can be annulled up to June 20th, with justifiction. After this date no refund will be given.