Name__________________________________________________Position/degree______________

Street Address_____________________________________________________________________

City, State, Zip___________________________________________________________________

Phone: (_______)___________________________________________________________________
     
FAX:   (_______)________________________  E-Mail: _________________________________
                                
Audiotapes of SSTI Annual Meetings are available in boxed sets of 12 cassettes:
$190 for non-members, $160 for SSTI Members (shipping & handling included).

___I can't attend this year. Please send audio cassettes of the 1999 conference.

___I missed the 1993 meeting "Toward a New Psychotherapy."
   Please send the album. 

___I missed the 1994 meeting "The Experience and Expression of Anger."
   Please send the album.

___I missed the 1995 meeting "Affect, Script and Psychotherapy."
   Please send the album.

___I missed the 1996 meeting "The When, When Not, and How of Brief Psychotherapy."
   Please send the album.

___I missed the 1998 meeting "The Philadelphia System: Affect and Script in
   Psychotherapy."  Please send the album.

I would like to join the Institute and get discounts for Institute
activities.  Membership fee: $45_________

Days Attending: (Please circle)  Friday-Saturday-Sunday, Saturday-Sunday,
                                 Friday Only, Saturday Only, Sunday Only

Workshops you plan to attend:

 Please Note: We will attempt to seat all registrants in the workshop of their
 choice. Please list your first and second choices for each morning and afternoon
 seminar by placing the numbers "1" or "2" next to your selection.

Saturday Afternoon  _____ Most     _____ Kelly      _____ Wright

Sunday Morning      _____ Little   _____ Murray     


   Total:  Conference __________________ 
           Tapes________________________
           Membership___________________ 
           Grand Total__________________
               
Check enclosed_________      Please Charge my MasterCard/Visa___________   

Card Number_________________________________  Expiration Date___________

Signature_______________________________________________________________

Send payment and completed application to:

     Tomkins Institute Conference
     255 South 17th Street  Suite 2403
     Philadelphia, PA 19103-6224