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Webinar Registration Form

PORTLAND INSTITUTE FOR LOSS AND TRANSITION

Collage: Practicum Studio

July 31, 2020 (Friday), 9am-11am, PDT

Collage Practicum - Publicity Poster (PN

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)

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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:

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.

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 double check your password

Confirm registration

Registration

Join this live stream webinar with an accompanying Course Pack and Responsive Journal,

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 enroll in Certification Program,

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

**Participants in this live stream webinar are eligible for certification credit for 1 Practicum Session.

Promotion code:

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Event Subtotal (USD): 

Est. Taxes & Fees(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 “Collage: Practicum Studio” live stream webinar 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 webinar commences: refund minus 10% service fee

   b) Within 1 week before webinar commences: No refund permitted

 

3. PI reserves the right to make any necessary changes to the webinar program without prior notice to the registrants.

Agreement

By registering for the “Collage: Practicum Studio” live stream webinar, 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.

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

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