CBT for Insomnia Registration Form
Workshop: Cognitive Behavioural Therapy for Insomnia: The Basics and Beyond
ONLINE LIVE STREAM EVENT
Dates: April 24, 2020
Location: Online Live Stream Event
Cost: $175 CAD + 13 % HST (= $197.75 CAD)
Registration Deadline: April 22, 2020 at 12pm
*Group Rates available for groups of 5+ people registering together OR for individuals registering for more than one workshop. See
for more information*
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 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. For those wishing to pay by cheque, credit card or Paypal, please go to the workshop page at
and choose the correct option under the Registration heading.
(if you are not employed by an organization, please just write your full name in this section - or "self-employed" if applicable)
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.
How did you hear about this event?
Check all that apply
I am on the Mission: Empowerment! Email List
I am on the Speaker's email list
Email from colleague/friend
Please add me to your mailing list
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!
Already on it!
No, Thank You
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.
I have reviewed the above cancellation policy and I agree to the terms
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