Workshop Registration Form
PORTLAND INSTITUTE FOR LOSS AND TRANSITION
GRIEF THERAPY LEARNING RETREAT
May 8-12, 2020
IMPORTANT! Site members please log in to link your data from the certification program.
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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):
$
$
$
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:
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Before February 1, 2020: refund minus 10% service fee
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February 1 – April 30, 2020: refund minus 20% service fee; and the Bon Secours room booking fee for stay-in registrants
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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..