REGISTRATION FORM – SUBMIT BEFORE 15 August 2013

1. PROFESSIONAL DEVELOPMENT WORKSHOP Date : 9 September 2013 Venue: Rumah Hospis Jalan Air Itam Pulau Pinang Organized by Penang Association of Counselling & Psychology (PACP) & Penang Counselling Group (PCG) 'Re-visiting the First Session: six areas of exploration for individual, couple and family clinicians - and one for the second session!’ Facilitator: Dr Barry Mason Dr Mason is the Chair of the Advanced Programme in Family Therapy Supervision at the Institute of Family Therapy in London and also co-Director of the Doctoral Programme in  Family Therapy in association with Birkbeck College, University of London. He is also a former Director of the Institute. He has a private clinical practice and is a consultant in family therapy to a number of mental health clinics. He has published many articles in journals and is the author/co-editor of four books. He has a great deal of experience in doing therapy with adolescents and their parents and has also worked with adolescents when he was a teacher - his first qualification. Dr Mason has been a regular visitor to SE Asia in the last 15 years mainly teaching in Singapore.  This is his fourth seminar in Penang,. Cost per workshop : members of PACP & Penang Counselling Group: RM200/= Others (nonNGO). : RM 300/= The program 8.30 – 9.00 am Registration 11.00am – 100pm Session 2 9.00 – 10.30am Session 1 1.00 – 2.-00pm Lunch 10.30 – 11.00 Tea break 2.00– 4.00 pm Session 3 REGISTRATION FORM – SUBMIT BEFORE 15 August 2013 • Full Name as in IC (capital letters): _________________________________________ • Organization: __________________________________________________________ • Postal Address: ________________________________________________________ • ________________________________________________________ • Tel #: ___________________________ h/phone: ____________________________ • Email: ______________________________________ • Tick selected workshop & fee applicable: • members of PACP & Penang Counselling Group: RM 200/= □ • others. : RM 300/= □ • : Mode of payment (tick one of the following) • Cash total amount RM ____________Cheque or bank draft # _______________ (All cheques must be crossed and made payable to Penang Association of Counselling and Psychology) Please direct all registrations and payments or enquiries to: pacp2008@gmail.com Penang Association of Counselling and Psychology (PACP) A/C No : CIMB 07090006768058 Rumah Hospis FAX: 04-2264676