This online form processes processes only registrations paid by credit card. If you wish to pay by cheque you can still register by mail. Please make cheques payable to Jack Hirose & Associates and mail to 1770 Orkney Place, North Vancouver, BC, Canada V7H 2Z1.
Phone 604-924-0296, Toll-free 1-800-456-5424, Fax 604-924-0239
Email registration@jackhirose.com | www.jackhirose.com



IDENTIFICATION | See privacy policy required fields = bold *

TERMS & CONDITIONS


Honorific


Please keep me informed
about future workshops
*

First Name*
Last Name*
Address*
City*
  
Province/State*  
Country*
 Postal/Zip*  
Telephone*
numbers only

Work 
Home 
Fax  
Email*


DISCOUNTS FOR GROUPS & STUDENTS


GROUP REGISTRATIONS: Register all group members individually online and pay the single rate by Visa, Master Card or Cheque. Payment must be received before the earlybird deadline.


Group members must name their group contact person on the registration form. Once all group members have registered and paid online, the contact person emails or phones our office with a list of group members to receive the group-rate rebate by cheque or reimbursed by credit card if paid by card.


FULL-TIME STUDENTS: Register and pay online (single rate). When we receive a letter from the attending institution confirming full-time student status a rebate cheque will be sent.


NOTE: Rebates are available only for those registrations made online before the ‘early bird deadline’.

CANCELLATIONS

Cancellations: If you are unable to attend, you are invited to send someone in your place. Please send the name of the alternate by phone, email or fax, so we may correct our records and minimize confusion at check-in. Refunds, minus a $40 administration fee, are paid for cancellations 14 days or more prior to the workshop. For cancellations closer to the event, a full credit, less the $40 admin fee will be issued towards future Jack Hirose & Associates Inc. training. No refund or credit is offered for cancellations less than one full business day prior to the workshop.


LIMITATIONS

Our liability is limited to refunds for workshop fees only. Jack Hirose & Associates Inc. reserves the right to cancel the workshop. Please make hotel & travel arrangements with this in mind.
Note: Jack Hirose & Associates is not responsible for any presenter’s or participant’s statements, acts, materials or omissions. The use of audio and video taping devices, beepers, and cell phones is not permitted at any workshop. Children and unregistered guests are not permitted in the meeting rooms.

AFFILIATION


Field of Work
Organization
OTHER DETAILS ABOUT
THIS REGISTRATION


NOTE: If registering with
a group, enter details of
the group contact person
CHOOSE WORKSHOP

SELECT AN EVENT TO SEE ITS REGISTRATION OPTIONS AND DISCOUNTS

HALIFAX: Four Day Intensive Training in Cognitive Behavioural Therapy with Dr. David Burns | October 18, 19, 20 & 21, 2010
CONFERENCE: Healing and Treating Trauma, Addictions & Related Disorders | November 16-19, 2010
LONDON: The Explosive Child: The Collaborative Problem-Solving Approach with Dr. Ross Greene, Ph.D. | December 8, 2010
WINNIPEG: Anxiety Disorders in Children & Adolescents: Recognizing and Treating the Emerging Epidemic with Dr. Paul Foxman, Ph.D. | December 1 & 2, 2010
WINNIPEG: The Hungry Ghost: Combining Science And Compassion In Working With Addictions with Dr. Gabor Mate, M.D. | November 29 & 30, 2010
EDMONTON: The Power Of Mindfulness: Mindfulness Inside And Outside The Therapy Hour with Dr. Ronald D. Seigel, PSY.D | October 28 & 29, 2010
CALGARY: Emerging Trends In Addiction Treatment with Dr. Gabor Mate & Dr. Cardwell C. Nuckols | November 3, 4, & 5, 2010 |
RICHMOND: Four Day Intensive Training Program in Cognitive Behavioural Therapy with Dr. David Burns | July 5 - 8, 2011 |
EDMONTON: Four Day Intensive Training Program in Cognitive Behavioural Therapy with Dr. David Burns | July 12 - 15, 2011 |
VANCOUVER: From Childhood Aggression To Youth Violence In Boys & Girls with Dr. James Garbarino | November 8, 2010
SASKATOON: From Childhood Aggression To Youth Violence In Boys & Girls with Dr. James Garbarino | April 11, 2011
DUNCAN: Rapid Recovery Techniques for Depression and Low Self-Esteem with Dr. David Burns | Feb. 24 & 25 2011
SASKATOON: Rapid Recovery Techniques for Depression and Low Self-Esteem with Dr. David Burns | April 18 & 19, 2011

   

Privacy Statement


What information is collected and how it is used
Personal data collected through this site consists of information submitted voluntarily during the registration process, including your name, job title, organization, mailing address, telephone and fax numbers and e-mail address. Access to data is limited to staff of Jack Hirose & Associates and others authorized to process registrations and organize the workshop.

Online conference registration and credit card processing
All credit-card payment information is communicated using the industry-standard SSL 128-bit encryption. Look for the lock in your browser window to confirm this. Credit-card information is NOT stored; transaction and authorization codes are.

© 2010 | JACK HIROSE & ASSOCIATES