Cost: $650 OR 1% OF YOUR GROSS INCOME FOR FIRST TIMERS, $325 FOR PREVIOUS ATTENDEES OR SUPPORT GROUP LEADERS.

Note: if you register at least one month before a scheduled workshop, first timers pay only $595 and returnees $295. You are on your own for accommodations and meals. However, if you need it, we can give you names of hotels or motels in the area.

Click here to pay by Credit Card.

Cancellation policy: If you cancel more than one month prior to a workshop, you are entitled to full refund or a full credit to another workshop. If you cancel less than one month prior to a workshop, you are entitled to a 50% refund OR a full credit for another workshop. Workshop credits must be used within one year.

Please print this form then fax or mail it to us.  Click here for a pdf form.

WHEN: ________________________________

WHERE: _______________________________

Name: _____________________________________________

Address: ___________________________________________

___________________________________________________

Phone: ____________________ (h) ____________________ (w)

E-Mail: ___________________________________________

Amount enclosed: __________

Do you need accommodation information? Yes/No (Circle one)

Mail check payable to:
IPA
PO Box 65111
Baltimore, MD 21209

For more information, contact Dr. Soifer at:
410-367-1253 (office)
410-367-1254 (fax)
info@shybladder.org

Copyright 1999-2008 Shy Bladder Center.

WARNING AND DISCLAIMER: This website is NOT a substitute for medical or legal advice and does not constitute the practice of law, medicine, psychiatry, clinical psychology, clinical social work, or any other mental health profession.  If you are having trouble urinating, you should always contact a physician since difficulty with voiding can be a symptom of a serious medical condition. We are a group of professional people and people who have suffered with paruresis. We have assembled a board and a board of advisors to help people cope with urinary dysfunction that has a psychological or social origin. On this website, we are NOT practicing medicine, psychiatry, clinical psychology, clinical social work or any other mental health profession. You should have your doctor evaluate your condition before diagnosing yourself, and seek the appropriate necessary mental health counseling if warranted. SBI, Inc. disclaims any and all legal liability whatsoever.