Basic Registration Fee before March 30, 1997         $130   __________
or
    Late Registration Fee  (after March 30)	         $150. 	__________
    Basic Registration Fee for Full-time Student         $ 50.	__________
or
    Late Registration Fee for Full-time Student 	 $ 70.	__________
   (Include Advisor statement of full-time student status)
    Gala Dinner  on Saturday Evening, July 12, 1997  $  40.x ___=________
					(write in number of tickets)
    Pre-conference workshops,  July 8, 1997
    ___ Fay Fransella 8:30 AM to 12:30 PM 		$ 60.  __________
 or ___ Michael Mohoney 8:30 AM to 12:30 PM 		$ 60.  __________
    ___	Hubert J.M. Hermans  2 PM to 6 PM           	$ 60.  __________
 or ___	Larry Leitner        2 PM to 6 PM		$ 60.  __________
	Or, if you register for two workshops		$  95.	__________
    Total   (Please enclose a check or money order in U.S. Dollars
	      payable to PCP12th Congress)			$ _________
		Your Name ________________________________________
		Address	________________________________________
 			________________________________________
		Telephone: _________________________  FAX: ___________________
		e-mail: _______________________________________________
Mail this registration form and a check or money order to:
Jerald Forster, Ph.D.,
University of Washington, Box 353600
Seattle, WA  98195-3600 
USA 
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