Brochure & Registration Form


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
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
Event Hosted by
The Aulneau Renewal Centre
Cost: $50.00/person
Phone: 204-987-7090
Fax: 204-987-8880
Email: [email protected]
Register by phone, email, or fax Attn: Tracey Nickel
Register online at For more information on Dr.
Mate please visit
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:
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:___________________________________________
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.