Workshop Registration Form

PORTLAND INSTITUTE FOR LOSS AND TRANSITION

Collage: Integrating the Torn Pieces

June 29, 2020 (Monday), 9am-11am, PDT

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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

Professional Background

*Name of Organization

*Address of Organization

*Type of Organization

Private Practice

Hospice / Palliative Care

Hospital

Community Services

Educational Institution

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Others:

*Discipline

Psychologist

Social Worker

Counsellor / Therapist

Clergy / Pastoral Care

Marriage & Family Therapist

Physician / Nurse

Professor / Lecturer

Researcher

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Coach

Art or Expressive Arts Therapist

Others:

Registration

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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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: Integrating the Torn pieces” 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.

Agreement

By registering for the “Writing through Bereavement” 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.

© 2020 by Portland Institute