Registration Form
Workshop: Adult Attachment in Clinical Practice: Understanding & Treating Insecure Adult Attachment
Dates: June 4 - 5, 2020
Location: Stratford, Ontario, Canada.
Early-Bird Cost: $399 CAD + 13% HST (=$450.87) by May 3, 2020
Regular Cost: $429 CAD + 13% HST (=$484.77) after May 3, 2020

Includes continental breakfast, lunch and afternoon refreshments.
*Group Rates available for groups of 5+ people registering together OR for individuals registering for more than one workshop. See for more information*

Important Notes:
1) Please ensure that your email address is entered correctly; the email address provided will be used to send the confirmation of registration, receipt, and any necessary communication regarding this registration.

2) Please note that the attendee names entered on this form will be used for the sign in sheet and certificates of completion, exactly as entered. Please be sure to capitalize the first letter in the first name and last name, otherwise there will no be capitals on the certificate.

**Note: This form is only for people who will be paying by e-transfer or cheque. For those wishing to pay by credit card or Paypal, please go to the workshop page at and follow the link provided in option # 1 under the Registration heading.
First Name: *
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Last Name: *
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Email Address: *
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Job Title: *
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Company/Organization: *
(if you are not employed by an organization, please just write your full name in this section - "self-employed" if applicable)
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Country: *
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Street Address: *
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City: *
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Province/Territory/State: *
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Postal Code: *
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Mobile/Home Phone (Please enter the best number to reach you on the day of the workshop in the unlikely case of cancellation or emergency): *
Please enter just one phone number where you would be most likely to be reached on the morning of the event.
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Please Specify Any Food Allergies or Dietary Restrictions and severity of allergic reaction if applicable (put N/A if not applicable): *
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How did you hear about this event? *
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If you don't want to miss out on any of our fantastic professional development events or personal development workshops, sign up for our mailing list below. We hold all events in Southwestern Ontario (usually Stratford or Kitchener) at venues with lots of FREE parking, and removed from the traffic headaches of the big city!
Cancellation Policy *
An administrative fee of $50 will be charged for all cancellations. Cancellation 14 or more days prior to the workshop date – receive a refund, less $50 administration fee. Cancellation less than 14 days prior to the workshop date – receive a credit, less $50 administration fee, to be applied to a future workshop. No credit or refund will be issued if you do not notify us in advance of the workshop date. You may transfer your registration to another person without prior notice. The organizers reserve the right to cancel the event due to under-enrollment, instructor illness or inclement weather. If a workshop is cancelled, any payment will be returned in full.
How will you be paying? *
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