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Workshop Registration Form
PORTLAND INSTITUTE FOR LOSS AND TRANSITION
2020 SEPTEMBER INSTITUTE
September 14-18, 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)
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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 (please select one of the two options)
5-Day Registration
Early Bird (until July 15, 2020): USD$925
Regular Fee (from July 16, 2020 onward): USD$1,000
Day Pass (Please check your selected day or days)
Early Bird (until July 15, 2020): USD$195/day
Regular Fee (from July 16, 2020 onward): USD$210/day
NOTE: For registrants who wish to purchase certification program,
the total price will be above price + USD 100$ enrollment fee
Dear participant,
To purchase the certificate program requires you to complete your learner profile. Please click the button below to complete your learner profile (another page) before we can process your registration.
Dear participant,
To join the certificate program requires you to create a learner profile on our site. Please set a password and complete your profile (another page) before you register the event. You will be able to login with your email and password.
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Monday (September 14, 2020)
Tuesday (September 15, 2020)
Wednesday (September 16, 2020)
Thursday (September 17, 2020)
Friday (September 18, 2020)
Yes, I wish to add the Certification Program to my order
APA Continuing Education (CE) Credits
Designated sessions will offer CE Credit during the 2020 September Institute. Earn unlimited CE credits by attending these sessions for a single fee. CE Sessions are identified by the CES 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:
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Event Subtotal (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 2020 September Institute as registered, you may write in to the Portland Institute (PI) to request for withdrawal and refund according to the following guidelines:
-
Before July 15, 2020: refund minus 10% service fee
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July 16 – August 31, 2020: refund minus 20% service fee
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September 1, 2020 onward: No refund permitted
3. PI reserves the right to make any necessary changes to the 2020 September Institute program without prior notice to the participants.
Agreement
By registering for the 2020 September Institute, 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.