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Name and Address

Account

Please enter a Username to create an account. If you already have an account please login before completing this form.

Username *

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Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores.

First Name *

Last Name *

Email (to be used for NIPPA mailings and for the NIPPA listserv) *

Phone *

Please provide your mailing address where you will receive Psychoanalytic Perspectives

Street Address *

City *

Zip Code *

Country *

State/Province *

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