Webinar Registration Form

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Please confirm the correct webinar selection

PORTLAND INSTITUTE FOR LOSS AND TRANSITION

IMPORTANT! Site members please log in to link your data from the certification program.

For site members, please log in.

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*Required field

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

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

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 

December 9, 2020, 9-11:30am, PDT

December 11, 2020, 8-10:30am, SGT

**Participants in this live webinar are eligible for the specified certification credit.

Promotion code:

Event Subtotal (USD): 

Est. Taxes & Fees(USD): 

Promotion code:

 

Est. Event Total (USD): 

$

$

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 above live 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 above 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.

© 2020 by Portland Institute