Workshop Registration Form

PORTLAND INSTITUTE FOR LOSS AND TRANSITION

GRIEF THERAPY LEARNING RETREAT

May 8-12, 2020

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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

Dietary Requirements

Other Special Needs (if any)

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

Others:

Art or Expressive Arts Therapist

Registration (please select one of the two options)

5-Day Non-Stayer Registration (Inclusive of Breakfast & Lunch per day)

Early Bird (until January 31, 2020):  USD$1,050

Regular Fee (from February 1, 2020 onward):  USD$1,150

NOTE: for registrants who wish to purchase Certification Program,

the total price will be above price + USD$100 Enrollment Fee

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

APA Continuing Education (CE) Credits

 

Designated sessions will offer CE Credit during the Portland Institute for Loss and Transition, Grief Therapy Learning Retreat. Earn unlimited CE credits by attending these sessions for a single fee. CE Sessions are identified by the CEP logo in the program. 

*Unlimited CE Fee

Yes, I would like to register for APA CE credits ($90)

No, I am not interested in CE credit

Promotion code:

no promotion code applied

Event Subtotal (USD): 

Est. Taxes & Fees(USD): 

Promotion code:

 

Est. Event Total (USD): 

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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 Learning Retreat as registered, you may write in to the Portland Institute (PI) to request for withdrawal and refund according to the following guidelines:

  • Before February 1, 2020: refund minus 10% service fee

  • February 1 – April 30, 2020: refund minus 20% service fee; and the Bon Secours room booking fee for stay-in registrants

  • May 1, 2019 onward: No refund permitted

 

PI reserves the right to make any necessary changes to the Grief Therapy Learning Retreat program without prior notice to the participants.

Agreement

By registering for the Grief Therapy Learning Retreat, 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 would like to subscribe to PI’s mailing list for its future updates on matters pertaining to PI-related workshops, events and services.

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