2000 BIDIP Conference | Registration Form

BOSTON INSTITUTE
FOR THE DEVELOPMENT
OF INFANTS AND PARENTS

Registration Form
2000 Annual Conference
http://www.bidip.org/conferences/RegForm2000.html

You can reach BIDIP at (617) 484-6603 or send e-mail to bidip@bidip.org

Discipline ______________ Degree___________________________
Name ______________________________________________________
Mailing Address ______________________________________________________
City, State, Zip Code ______________________________________________________
If the above is a new address, please give your OLD Zip Code ___________
Telephone Day_____________________ Evening________________________
Institutional Affiliation___________________________________________
Credits (circle choice) AMA APA NASW SS/NASW#______________ LMHC Nurses Educators: PDP OFC

Every effort will be made to assign you to your first choice workshop.
Early registration will ensure choice.

Attendee Fee* Schedule: Conference fee / BIDIP, NECCAP members discounted conference fee
*Lunch is included in fee
*Paying dues with this registration entitles you to the member's discount on conference registration fee.

PhD/EdD clinicians, MDs: $110 / $100
Other Professionals: $90 / $80
Students, Professionals-in-training, and MEIC members: $60 / $60

_______ Conference Fee
_______ $5 CEU certificate charge
_______ $10 Late fee if received after October 23
_______ BIDIP Membership 2000-2001 (circle one if joining now): Regular - $25 / Student - $15

_______ TOTAL ENCLOSED

Make checks payable to BIDIP and mail with your registration form to:
BIDIP Conference
26 Trapelo Road
Belmont, MA 02478

Last update: September 13, 2000
BIDIP e-mail to: bidip@bidip.org
Website e-mail to: webmaster@bidip.org

BOSTON INSTITUTE FOR THE DEVELOPMENT OF INFANTS AND PARENTS

BOSTON INSTITUTE
FOR THE DEVELOPMENT
OF INFANTS AND PARENTS