Society for the Study of Psychiatry and Culture
Annual Meeting Exhibitor Application
2016
Date:____________________________________________________________
Name:___________________________________________________________
Title:____________________________________________________________
Company/ Agency
Name:___________________________________________________________
Address:________________________________________________________
Phone number:_______________________Fax__________________________________
Email address:_________________________________________________________
Please make checks payable to the Society for the Study of Psychiatry and Culture.
The Society for the Study of Psychiatry and Culture Tax Identification number is: 931133972. SSPC is a not for profit organization incorporated in the State of Oregon.
Amount enclosed________
We are: (Please check one)
A for profit company_____
A non-profit organization or government agency_______
Please send your application and check payable to SSPC to:
Liz Kramer, Executive Director
Society for the Study of Psychiatry and Culture
1001 City Avenue, #ED232
Wynnewood, PA 19096