Seminar Registration Form

For more information contact the Coping Centre (see below)

Please provide the following information:

Name:
Street Address:
Address (cont.)
City:
State/Province:
Zip/Postal Code:
Work Phone:
Home Phone:
E-mail:

I would like to apply for the following seminars: (Please check box)

Wolfelt Seminars
	Understanding and Responding to Complicated Mourning
	Sept. 18 - 20, 2007
	Counseling Skills Fundamentals
	Nov. 6 - 8, 2007
	Comprehensive Bereavement Skills Training
	Sept. 16 - 18, 2008
	Exploring the “Shadows of the Ghosts of Grief”
	Nov. 4 - 6, 2008

Accomodations Required?: Yes No

Dates Accomodation Required:

Background Statement:
Please attach your background statement.
(e.g. name, age, occupation, brief work history, losses in your own life, interest in the particular seminar(s) you have selected and anything else you think we should know.)

Upon receipt of your registration,
background statement and deposit, your application will
be reviewed. We will then send you a letter
of confirmation. We look forward to seeing you!

Ros Crichton
COPING CENTRE
1-877-554-4498 or 519-650-0852
Fax: 519-650-1949
Email: coping@copingcentre.com