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第四届国际温尼科特协会学术大会报名表 Application form IV IWA Congress-Beijing
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1.
您的姓名/Name:
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2.
您的性别/Gender:
男/Men
女/Women
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3.
您所在的国家/Country
中国/China
其他国家/Other countries
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4.
请输入您的联系地址(用于邮寄证书):
姓名:
姓名:
所在地区:
所在地区:
街道地址:
街道地址:
手机或固话:
手机或固话:
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5.
邮箱/E-mail
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6.
您目前从事的行业/Your current industry:
【多选题】
心理咨询师/Psychological counseling
精神分析师/Psychoanalyst
教师/Teacher
心理学家/psychologist
社会工作者/Social worker
学生/Student
医生/Doctor
其他/Other
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7.
您所加入的IWA会员小组/The IWA member group you are affiliated:
请选择
AP- Portuguese Association of Psychoanalysis and Analytical Psychotherapy
Athens Winnicott Group
北京温尼科特学习与研究小组/Beijing Winnicott Study and Research Group
Chinese Winnicott Association
Córdoba Winnicott Group
Independent Psychoanalysis: Radical Breakthroughs
Israel Winnicott Center (IWC)
IWA France
Liège Winnicott Group
Rome Winnicott Group
上海温尼科特小组/Shanghai Winnicott Group
The Winnicott Trust
Winnicott Institute - Brazilian Institute of Winnicottian Psychoanalysis
Winnicott Society - Brazilian Society of Winnicottian Psychoanalysis
还未加入任何小组/Not affiliated yet
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