Program Registration Please identify which workshop, course, or program you are registering for:(Required) Chronic Illness Art Therapy Group – February 2025 Start Social Skills for Those with ID Forgotten Victims: Family and Friends of Those Who Have Committed Serious or Sexual Crimes Register of Interest(Required) This support group runs based on numbers and expressed interest. By completing the form below you confirm that you are wishing to register your interest in attending future dates of this support group, and consent to being contacted via the details provided below.Attendee Name(Required) First Last Attendee PhoneAttendee Email(Required) Invoicing Details As above Invoice to different details Address Invoice To: First Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email Please use the below space to record any additional information or questions that may be relevant.Consent to Register in Program(Required) I understand that submitting this form constitutes my applation to register for the group program. Once processed, I will be sent an invoice for payment of program fees. I understand that payment must be received in full in order to secure my place in this group program.Consent(Required) I understand that minimum numbers are required in order for this group program to run, and that if these numbers are not met, the program will not commence and a full refund will be issued. You will be added to the expression of interest list, and offered a place in any future dates once numbers have been confirmed.(Required)Cancellation Policy(Required) I understand that payment covers one place within the 5-week program. As this program requires minimum numbers to run, I understand that no refund will be provided in case of booking cancellation or no-show for any or all of the group program dates. Where possible, if cancellation occurs prior to the commencement of the group, and another suitable attendee has been identified and enrolled, your fees will be refunded. Meliora Psychology will endeavour to fill spaces where cancellation has occurred, but refund will not be provided in instances that this has not occurred.Consent(Required) Terms and ConditionsMeliora Psychology Terms & Conditions Meliora Psychology is an independent psychology practice and training organisation and is not affiliated with any professional associations or organisations other than those stated on each individual workshop or training event. Meliora Psychology makes no representation that our workshops, group programs, and training events are affiliated with any accreditation bodies, associations and/or organisations, unless explicitly stated for a specific event. These group programs are designed to complement any individual therapy you may be engaged in, and not act as a replacement for individual therapy where there are mental health symptoms present. Bookings and Registration Group support program places are limited and will be booked on a first come first served basis. A person is not registered for this program until the completed registration is received and program payment has been processed in full. Applications will be processed according to the advertised cost & conditions. Tax receipts will be made out to the applicant unless otherwise stated. The applicant is responsible for supplying clear and correct information; any changes or additional contact required by Meliora Psychology may incur an administration fee. Cancellation & Refunds Policy Should you wish to cancel your registration, an administrative charge of $50 (inc GST) will be made for cancellations received in writing at least 30 days prior to the programs start date. No refunds will be offered for cancellations made within 30 days of the program start date. The only exception to this is where a waitlist is in operation for a program, and a suitable attendee is able to be registered and fees fully paid prior to the program start date. Where this occurs, your fees will be refunded minus a $50 administration fee. Cancellation of a Program by Meliora Psychology In the event Meliora Psychology needs to cancel the group program, then a full refund will be made of any registration fee paid by an attendee. Meliora Psychology will not be responsible for any cost other than any payment made by you for workshop registration. Change to Event Meliora Psychology reserves the right to make any changes to any events, programs or workshops without notice. This includes changes to the scheduled date of the event as well as the substitution of an alternative facilitator if the advertised facilitator is not available. In the event that a workshop facilitator is unable to complete a Meliora Psychology workshop or program, then Meliora Psychology reserves the right to substitute another experienced facilitator to complete the program. Video/Audio Taping and Photography Policy The Audio / Video recording and taking of photos (including camera phones) at Meliora Psychology events, groups, and programs is strictly prohibited, unless written consent has been obtained prior and all attendees have been made aware. Meliora Psychology reserves the right to take photographs and record video and/or audio at our events or programs for future promotional and archival use that do not include information or imagery that could reasonably identify you. Any images that do contain this information, or within which you could reasonably be identified will only be taken after explicit notification of this and consent from you. Copyright Any content or materials provided in the course of group programs or workshops is the property of Meliora Psychology and is protected by international copyright laws. Information provided in programs or workshops is for personal use only and may not be sold or otherwise distributed. Learning materials and processes are designed for participants only and not to be used to support others. Materials are protected by Australian and international copyright and trademark laws. Privacy Statement Meliora Psychology is committed to protecting privacy and the confidentiality and security of the personal information provided to it. Any personal information provided to Meliora Psychology in the course of applying for or completing workshops or group programs will be used to process registration. Pursuant to its contractual obligations with the National E-Health Transition Authority, Meliora Psychology may be required to provide access to personal information to the Commonwealth Auditor General, the Privacy Commissioner, the Ombudsman or a delegate of the National E-Health Transition Authority. Meliora Psychology may also be required to disclose your personal information to our professional advisers, including auditors. Applicants may access their personal information held by Meliora Psychology, subject to the exceptions in the Privacy Act 1988, and to correct any information which is incorrect. Please contact Meliora Psychology with any such request. I confirm that I have read the above and consent to Meliora’s Terms and Conditions.
