APAGS Internship Workshop Registration Form

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	American Psychological Association of Graduate Students	APAGS 2004 Pre-Convention In-Depth Internship Workshop Time: July 27th from 5:00-9:00pm Place: Hilton Hawaiian Village Beach Resort and Spa Tapa Ballroom III
Please Print or Type Your Information! The Deadline for Pre-Registration is June 15, 2004
Name:			Workshop Registration Fees: (Please Note: The registration fee for this pre-convention workshop is separate from your APA Convention registration.) Before June 15, 2004: $25* APAGS members $30 Non-APAGS members After June 15, 2004: $30* APAGS members $35 Non-APAGS members The pre-registration fee includes, Internships in Psychology: Writing Successful Applications and Finding the Right Match (Williams-Nickelson & Prinstein, Eds). All Pre-Registrations Must Be Pre-Paid.
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APA ID Number*:
*Please include your 8-digit APA ID number to take advantage of the APAGS $5.00 discount (you can find your APA ID number on your APA Membership card or by calling 1-800-374-2721).
To Pay by Check: Please make check out to APA. Checks must be in US dollars and drawn on a US bank.		To Pay by Credit Card, please provide the following information:
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Print this form and fax it to APAGS at 202-336-5694 OR Send it to: APAGS/Workshop 750 First St NE Washington DC 20002-4242
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