Application form - Psychoanalytic Conference in Baku, 2018
Participation fee*

Payment until 31.01.2018 - 50 euro

Payment until 28.02.2018 - 60 euro

Payment until 31.03.2018 - 70 euro

Payment until 11.05.2018 - 75 euro

*For students participation fee is 50 euro at any time of payment

Name *
Your answer
Home address
Your answer
Email, telephone *
Your answer
Are you a member of ECPP?
Your answer
Do you practice psychoanalysis?
Your answer
Academic degree, rank, qualification
Your answer
Are you a student studying psychoanalysis? Indicate institution
Your answer
Your participation at the conference (listener or presenter?)
Your answer
Are you joining the cultural event?
Your answer
Do you want us to book business-lunch for you? For Friday? For Saturday?
Your answer
Do you need help in booking a hotel room?
Your answer
Date & time of your arrival/departure
Your answer
Your wishes
Your answer
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