Brochure & Registration Form
Transcription
Brochure & Registration Form
the Biology of Loss: What Happens When Attachments are Impaired? March 18, 2015 7:00 to 8:30pm University of St. Boniface 200 Ave. de la Cathedrale What happens when children experience emotional loss in early childhood? Whether due to abuse in the family or simply stress on the parents, the ability to be aware of and responsive to their children’s emotional needs often suffers. Mental health implications and the impact of the environment on childhood brain development will be addressed, along with ways of recognizing and helping to heal the negative consequences of early loss. Event Hosted by The Aulneau Renewal Centre Cost: $50.00/person Phone: 204-987-7090 Fax: 204-987-8880 Email: [email protected] www.aulneau.com Register by phone, email, or fax Attn: Tracey Nickel Register online at www.aulneau.com For more information on Dr. Mate please visit www.drgabormate.com Registration form on reverse. Please register by March 11, 2015. Fee is payable by cash, credit card, cheque, debit. Cash and debit available in person at 228 Hamel only. Invoicing also available upon request. The Biology of Loss: What Happens when Attachments are Impaired? EVENING March 18, 2015 Mail / Fax registration to: The Aulneau Renewal Centre 228 Hamel Avenue, Winnipeg, MB R2H 0K6 Telephone: (204) 987-7090 Fax: (204) 987-8880 E-mail: [email protected] Name: ________________________________________ ____________________________________________ Street Address: ________________________________________ City: ____________________ Prov.: _______ Postal Code: _____________ Phone (H): _______________________ Phone (W): ________________________ E-mail: ____________________________________________________________________________________ TOTAL: $__________________ Event Fee: $50.00/person If registering in a group (3 or more persons) for in-person attendance please fill out following section Names of other registrants in group: _____________________________ ____________________________ _____________________________ ___________________________ _____________________________ ___________________________ _____________________________ ___________________________ _____________________________ ___________________________ Disclaimer: We encourage each group member to fill out a registration form with their contact information so they may be kept informed with additional training opportunities. Total Number of Participants: ___________ x ($50.00) = TOTAL: $__________________ Please register by March 11, 2015. Receipt of payment will confirm registration. Payment Options: Cheque (payable to the Aulneau Renewal Centre) □ Card Number:___________________________________________ VISA □ Mastercard □ Invoice □ Expiry Date:_____________________ Name on Card:___________________________________________ Signature of Cardholder:___________________________________ Total : $________________________ If requesting an invoice, please indicate to whom and where it should be sent: ATTN: ________________________________________________________________________ Address, Fax Number, OR E-mail Address: Same as above □ or as follows: _______________________________________________________________________________ Lecture begins at 8:00pm and ends at 9:30 p.m. Please arrive a few minutes early to check in. Registrations are non-refundable but are transferable to a substitute participant by request. The Aulneau Renewal Centre reserves the right to cancel events that receive low registration numbers. In the event of a cancellation, participants will receive notification via emails and phone calls.