Workshop Registration Form
PORTLAND INSTITUTE FOR LOSS AND TRANSITION
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)
State / Province (if applicable)
Other Special Needs (if any)
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*Name of Organization
*Address of Organization
*Type of Organization
Hospice / Palliative Care
Counsellor / Therapist
Clergy / Pastoral Care
Marriage & Family Therapist
Physician / Nurse
Professor / Lecturer
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 purchased certification program,
the total price will be above price + $100 certification fee
**Participants in this online workshop are eligible for certification credit for 1 Technique Module.
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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 “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.