AOOP: Academy of Occupational and Organizational Psychiatry

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Annual Meetings

14th Annual Conference of the
Academy of Organizational & Occupational Psychiatry

"Occupational Psychiatry in the 21st Century: Challenges and Opportunities"

January 17 - 19, 2003
The Monarch Hotel
Washington, DC

Pre-Conference Schedule • Main Program Schedule • Faculty
Hotel Information • Registration Form • Joint Sponsor • General Information

Registration Form

Note: This form is not submitted online.

Please complete the registration information and mail to:
AOOP
717 Princess Street
Alexandria, VA 22314
or fax to:
1-877-789-6050

Name:

Company:

Address:

City:
 State:
 Zip:

Phone Number:

Fax Number:

E-mail address:

For Membership Only:

The information from above will be published in our membership directory and used for all correspondence unless you note otherwise. You may also provide us with your C.V. for our files.

Name (first, middle initial, last) and your degree

Corporate Title:

Hospital/Group Name:

Web site address:

Academic Information

Medical School
Year

Residency
Year

Fellowship
Year

ABPN (or foreign equivalent)
Year

Diplomat Yes No

Other Training

Current academic affiliation:

Current academic title:

State license(s):

Signature: Date:

Payment Type

Check (payable to AOOP)
Credit Card: Visa    Mastercard    AmEx

Name on Card:

Card Number:
   		 Exp. Date:

Signature of Cardholder:

Fees & Membership Dues:

Please select all that apply.

  Rcv'd by
12/6/02		 Rcv'd After
12/6/02
Main Conference Program (1/19-20)
General Member/Affiliate Member* $300.00
 $350.00
Member in Training* $60.00
 $75.00
Corresponding Member* $300.00
 $350.00
Non-Member $350.00
 $400.00
 
Pre-Conference Workshop I (1/17)
(Psychiatric Disability Examinations)
Member* $150.00
 $200.00
Non-Member $200.00
 $250.00
 
Pre-Conference Workshops II (1/17)
(Introduction to Consulting in Organizational and Occupational Psychiatry)
Member* $150.00
 $200.00
Non-Member $200.00
 $250.00
 
Pre-Conference Workshops I & II (1/17)
(discount for combined registration)
Member* $225.00
 $275.00
Non-Member $325.00
 $375.00
 
Pre-Conference Workshops III (1/17) (1/17)
(Psychoanalytic Dinner)
Member* $90.00
 $105.00
Non-Member $110.00
 $135.00
 
AOOP Membership Categories &
Membership Dues
General Member-US $150.00
 $150.00
General Member-Canada $120.00
 $120.00
General Member-International $750.00
 $75.00
Affiliate Member $150.00
 $150.00
Member in Training $30.00
 $30.00
Corresponding Member $75.00
 $75.00

Total Enclosed: 

Note: This form is not submitted online.

Please complete the registration information and mail to:
AOOP
717 Princess Street
Alexandria, VA 22314
or fax to:
1-877-789-6050

*Please note that you must be current with your membership with AOOP for the 2003 membership year to qualify for these member rates. Otherwise you will be considered a non-member. If you have any questions, please contact us at 1-877-789-2667.

Refund Policy: Cancellations will only be accepted through December 6, 2002. No refunds of conference fees will be made after December 6. Membership dues are nonrefundable.

Special accomodations for those with disabilities are available upon request.

Pre-Conference Schedule • Main Program Schedule • Faculty
Hotel Information • Registration Form • Joint Sponsor • General Information

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