Boston Institute for Psychotherapy - Film Series Registration

IMPORTANT:
One form per registrant. Names of registratns will be held at the door, no confirmation will be sent.

REFUND POLICY:
Refunds, less a handling fee of $5 will be made for cancellation requests received by 5pm, seven days before the film.

No refunds will be given for full series registration after February 15, 2012. All refunds will be made post-series.

Psychology Goes to the Movies

Identities in Crisis – Shifting Sands of Self in Society
A classic film and discussion series on contemporary issues in psychotheraphy and psychoanalysis

Friday evenings in March, from 7pm - 10:30pm
University Hall Amphitheater, 2nd Floor
Lesley University

Film Selections:

March 2 - Brokeback Mountain
2005; director: Ang Lee
Discussant: Mark O'Connell, PhD

March 9 - Daughter from Danang
2002; directors: Gail Dolgin, Vicente Franco
Discussant: Kimberly Leary, PhD

March 16 - L.I.E.
2001; director: Michael Cuesta
Discussant: Susannah Sherry, MD

March 23 - Eve's Bayou
1997; director: Kasi Lemmons
Discussant: Judith A Yanof, MD

March 30 - The Great Santini
1979; director: Lewis John Carlino
Discussant: Rafael Ornstein, MD

Name:
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Please Check One of the Following:
$10 BIP Member/Student Film Only
$14 Non-Member Film Only
$27 BIP Member Film and CEs
$34 Non-Member Film and CEs

Series Discounts:
$45 All Five Films, BIP Member/Student (Films Only)
$65 All Five Films, Non-Members (Films Only)
$120 All Five Films, BIP Members (Films & CEs)
$150 All Five Films, Non-Members (Films & CEs)

For Continuing Education Credit Only. Please check one
Licensure:
Pysch
LICSW
LCSW
LMHC
Other(specify)
License #: State:

Payment Type:
Charge

Membership Code (if applicable )