Workshop Registration Form


Living in A Shattered World:

Claiming Our Losses and Re-anchoring Our Lost Footing

July 17, 2020 (Friday), 9am-11am, PDT or
July 20, 2020 (Monday), 9am-11am, SGT

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


*Email Address



State / Province (if applicable)


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


Community Services

Educational Institution

Funeral Home




Social Worker

Counsellor / Therapist

Clergy / Pastoral Care

Marriage & Family Therapist

Physician / Nurse

Professor / Lecturer


Funeral Service


Art or Expressive Arts Therapist



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:

NOTE: For registrants who wish to purchase Certification Program,

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

**Participants in this online workshop are eligible for certification credit for 1 Practicum Session.

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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 “Living in A Shattered World” 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.


By registering for the “Living in A Shattered World” 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.

Dear participant,

To complete the purchase as a site member, please make sure you are logged in.

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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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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.

Please make sure to complete all the required fields in the registration form.