2010 SPA Annual Meeting Registration Form
March 24-28, 2010
The Fairmont Hotel, San Jose CA
  Annual Meeting Registration: All participants, presenters, leaders in scientific sessions, and workshops are required to complete a registration form (even if your fee has been waived). Please check your membership category, indicate your workshop preferences, if appropriate, and note the amount due in the spaces provided for each registration.

Workshop Registration: Enrollment in the workshops will be filled on the basis of completed workshop registration forms and fees received. Continuing Education credits and certificates are available for pre-registrants upon completion of the workshop. See brochure for details.

Cancellation Policy: Refunds will be granted prior to February 24, 2010, less a $75 administrative fee. No refunds will be granted after February 24, 2010.

Name (as you wish it to appear on the nametag):

First Name Middle Name Last Name Suffix Degree
Business Home Address   
City State Zip/Postal Code   Country
Phone (daytime)    Fax       Email Address
Last 4 digits of your Social Security #      Do not include my email in a list for meeting participants
Membership and Participant Status (please check all that apply)
New Member Applicant Award Winner/Tribute Presenter
Member/Associate Workshop Leader/Master Lecturer 
Fellow Presenter (paper, poster, symposium)
Student Student Volunteer
Non-Member New Attendee
How did you learn of the Annual Meeting?
SPA Member Mailing
Mailing to State Psych Assoc 
Newsletter Poster
Website Other
Conference Registration Fees
 
Online Registration by2/24/10
After 2/24/10 or On-Site
Member/Fellow/Associate      $215.00      $265.00
Non-Member       $285.00        $335.00
Member/One-Day Fee       $145.00        $145.00  
Non-Member/One-Day Fee       $165.00       $165.00  
Student         $75.00        $90.00
Student/One-Day      $50.00       $50.00
Student Volunteer      $50.00       $50.00  
Student Luncheon      $10.00      $10.00 
Irving B. Weiner Dinner  #Guests:      $48.00 each        $48.00 each
Fee Waived      $0.00       $0.00 
                  Total $
 
I plan to attend the Assessment Research Interest Group, Friday, March 26, 12:00-1:15 pm
I plan to attend the Collaborative/Therapeutic Assessment Interest Group, Friday, March 26, 12:00-1:15 pm
I plan to attend the International Members Meeting, Friday, March 26, 12:00-1:15 pm
I plan to attend the Forensic Psychology Interest Group, Saturday, March 27, 12:15-1:30 pm
I plan to attend the Psychoanalytic Assessment Interest Group, Saturday, March 27, 12:15-1:30 pm
Workshop Registration
Member or
Conference Registrant
Non-Member
Non-Conf Registrant*
Student
Workshops - Wednesday, March 24   
      8:00 am- 4:00 pm #1 (Full Day)     $175     $225    $90
      8:00 am- 4:00 pm #2 (Full Day)     $175     $225    $90
      8:00 am- 4:00 pm #3 (Full Day)     $175     $225    $90
      8:00 am- 4:00 pm #4 (Full Day)     $175     $225    $90
      8:00 am-11:30 am #5 (Half Day)     $105     $140    $50
      8:00 am-11:30 am #6 (Half Day)     $105     $140    $50
      1:00 pm- 4:30 pm #7 (Half Day)     $105     $140    $50
      1:00 pm- 4:30 pm #8 (Half Day)     $105     $140    $50
      5:00 am- 8:30 pm #9 (Half Day)     $105     $140    $50
Workshops - Thursday, March 25   
      8:00 am-11:30 am #10 (Half Day)     $105     $140    $50
      8:00 am-11:30 am #11 (Half Day)     $105     $140    $50
      8:00 am-11:30 am #12 (Half Day)     $105     $140    $50
      8:00 am-11:30 am #13 (Half Day)     $105     $140    $50
      8:00 am-11:30 am #14 (Half Day)     $105     $140    $50
Workshops - Sunday, March 28   
      8:00 am- 4:00 pm #15 (Full Day)     $175     $225    $90
      8:00 am- 4:00 pm #16 (Full Day)     $175     $225    $90
      8:00 am- 4:00 pm #17 (Full Day)     $175     $225    $90
      8:00 am- 4:00 pm #18 (Full Day)     $175     $225    $90
      8:00 am-11:30 am #19 (Half Day)     $105     $140    $50
      1:00 pm- 4:30 pm #20 (Half Day)     $105     $140    $50
Total  $

*This category applies to non-members of SPA who wish to take workshops, but are not registered for the conference itself.


Some workshops exceed capacity quickly. Please indicate, in order of preference, other workshops you would
be interested in attending #
, # , # , # .
Because of limited workshop space, priority will be given the SPA members. SPA reserves the right to cancel any workshop.

Summary of Fees
       
Total Conference Registration   $  
Total for Student Luncheon   $  
Total for Irving B. Weiner Dinner   $  
Total Workshop Registration   $  
Total Fees Due to SPA     $
       
(Click the "Submit" button to enter your credit card information and print a copy of the registration form)