The American Academy of Psychoanalysis and Dynamic Psychiatry

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1. MAIL:	Print or type your information on this form, and mail to: American Academy of Psychoanalysis and Dynamic Psychiatry One Regency Drive, P. O. Box 30 Bloomfield, CT 06002-0030
2. FAX:	Print or type your information on this form, and send to: FAX: (860) 286-0787, ATTN: Lorraine Browne, AAPDP TEL: (888) 691-8281
3. WEBSITE:	Submit the form from the Academy Website by Clicking Here. When we receive your submission from the Website, you will receive a confirmation email from the Academy office.