Workshop Registration Form

PORTLAND INSTITUTE FOR LOSS AND TRANSITION

2020 SEPTEMBER INSTITUTE

September 14-18, 2020

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

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

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 

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

Promotion code:

Event Subtotal (USD): 

Est. Taxes & Fees(USD): 

Promotion code:

 

Est. Event Total (USD): 

$

$

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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 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

  • July 16 – August 31, 2020: refund minus 20% service fee

  • 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.

© 2020 by Portland Institute