Scand J Psycho1 33 (1992) Announcement 19 1

THE FIFTH NORDIC MEETING O N BEHAVIOUR THERAPY REYKJAVIK ICELAND, APRIL 23-25, 1992

CONGRESS REGISTRATION FORM

Must be received no later than February 15, 1992

PARTICIPANT:

Name: ............................................................................................................................................................ Title: .....................

Address: ......................................................... .............................................................................................................................

............................................................................ country: .... ......................

Phone: ............................................................................................... Fax: ...................................................................................

Accompanying person(s): .............. .............................................................................................................................

.....................................................................................................................................................................................................................

A. CONGRESS REGISTRATION FEE

Member of a Nordic Behaviour Therapy Association SEK 1280 0 Non-Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SEK 1390 0

. . . . .

B. PRE-CONGRESS REGISTRATION FEE

Member of a Nordic Behaviour Therapy Association SEK 920 0 Non-Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SEK 980 0

. . . . .

My first choice is workshop ao. ..................... My second choice is workshop no. ................... My third choice is workshop no. .....................

C. CONGRESS AND PRE- CONGRESS REGISTRATION FEE

Member of a Nordic Behaviour Therapy Association SEK 1990 Non-Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SEK 2200 0

. . . . .

D. CONGRESSBANQUET . . . . . . . . . . . . . . . . . . . . . . SEK 390 0

PAYMENT

TOTAL SUM A + B or C + D . . . . . . . . . . . . . . . . . . SEK ...............

1. Send a cheque payable to the Icelandic Behaviour Association on our office's address: The University of Iceland, Institution for Continuing Education, Dunhaga 5, 107 REYKJAVIK, Iceland.

2. Pay to our account No. 0532-38-560007 at Islandsbanki. 3. We credit your VISA account No. ........................................................ (16 digits).

We credit your EUROCARD account No. ........................................................ (16 digits). Card expires end of ..................................

.............................................................................................................................................................................................. Dmtc and p l r c Sgnuurc of credit urd holder