Workshop Registration Form

PORTLAND INSTITUTE FOR LOSS AND TRANSITION

When Grief Goes Viral

Psychological Assessment and Intervention in the Corona Crisis

May 29, 2020 (Friday), 9-11am, PDT or
June 8, 2020 (Monday), 9-11am, SGT

IMPORTANT! Site members please log in to link your data from the certification program.

For site members, please log in.

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Personal Particulars: (for site members, please login to auto fill the basic information)

*First Name

Middle Initial

*Family Name

*Phone

*Email Address

*Address

*City

State / Province (if applicable)

*Country

Professional Background

*Name of Organization

*Address of Organization

*Type of Organization

Private Practice

Hospice / Palliative Care

Hospital

Community Services

Educational Institution

Funeral Home

Others:

*Discipline

Psychologist

Social Worker

Counsellor / Therapist

Clergy / Pastoral Care

Marriage & Family Therapist

Physician / Nurse

Professor / Lecturer

Researcher

Funeral Service

Coach

Art or Expressive Arts Therapist

Others:

Registration

Join this live online workshop with an accompanying Course Pack, as well as the opportunity to
interact through breakouts and the question and answer period.
*One registration is only intended for one participant and cannot be shared among multiple learners.

Please kindly indicate which session you would like to join:

May 29, 2020 (Friday), at 9-11am, PDT: USD$99

June 8, 2020 (Monday), at 9-11am, SGT: USD$99

NOTE: for registrants who wish to purchased certification program,

the total price will be above price + $100 certification fee 

Yes, I wish to add the Certification Program to my order

**Participants in this online workshop are eligible for certification credit for 1 Technique Module.

Event Subtotal (USD): 

Est. Taxes & Fees(USD): 

Promotion code:

 

Est. Event Total (USD): 

$

$

$

no promotion code applied

Terms and Conditions  

1. You will receive a confirmation of registration via email upon payment completion.


2. Refund policy
Should you be unable to attend the “When Grief Goes Viral” online workshop as registered, you may write in to the Portland Institute (PI) to request for withdrawal and refund according to the following guidelines:
a) 1 week before workshop commences: refund minus 10% service fee
b) Within 1 week before workshop commences: No refund permitted


3. PI reserves the right to make any necessary changes to the workshop program without prior notice to the registrants.

Agreement

By registering for the “When Grief Goes Viral” online workshop, I acknowledge and agree with the above-mentioned terms and conditions. I consent to the use of my personal data and payment details for this registration.

* I DO NOT wish to be included in PI’s mailing list for its future updates on matters pertaining to PI-related workshops, events and services.

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