Christine A. Padesky,Ph.D.

yHow to applyz

Please complete the following application form and return by e-mail or alternatively please print out and return by FAX.

Once we have confirmed your payment, your application will be accepted formally and an gAttendance ticketh and gAccess maph will be sent to you.

š@Please pay your attendance fee within one month after your application.
@@ If we cannot confirm your payment within one month, we will cancel your application.

š@The number of places is limited and therefore application without payment (i.e. application
@@ form only) does not guarantee a place.


After all places are sold, applications will be placed on a waiting list and you will not be required to pay the attendance fee unless a place becomes available.
yPaymentz

Payment of attendance fee will not be accepted on the day of the workshop.  Please pay your attendance fee beforehand through one of the following methods:

<Reservation on payment>

1. Money transfer through Japan Post Service Co., Ltd.
@@@Account Name: Yokohama Shinri Soudan Center
@@@Code: 10270
@@@Account No.: 88919431

2. Money transfer through bank
@@@Bank Name: Mizuho Bank, Shinyokohama branch office, ordinary account
@@@Account Name: Yokohama Shinri Soudan Center
@@@Account No.: 1441315

3. Money transfer through bank
@@@Bank Name: Yokohama Shinkin Bank, Rokukakubashi branch office, ordinary
@@@account
@@@Account Name:Yokohama Shinri Soudan Center
@@@Account No.: 183161

4. Cash registered mail

yCancellation policyz

Please inform us promptly if you wish to cancel your place.  The following cancellation fees will be applied:

Workshop I
Title: Harnessing Hope & Reducing Relapse: Engaging Clients in CBT for Depression

On or before April 18, 2009, your attendance fee will be refunded with a handling fee of JPY1,000.- deducted therefrom.
On or after April 19, 2009 (2 weeks before the workshop), your cancellation is not accepted (i.e. no refund will be possible).  We recommend you to appoint a substitute in this instance.

Workshop II
Title: The NEW Paradigm: A 4-Step CBT Model for Treating Personality Disorder

On or before April 21, 2009, your attendance fee will be refunded with a handling fee of JPY1,000.- deducted therefrom.
On or after April 22, 2009 (2 weeks before the workshop), your cancellation is not accepted (i.e. no refund will be possible).  We recommend you to appoint a substitute in this instance.

Application for both workshops

The same procedure as described above applies.  However, if you wish cancel either one of the workshops, your attendance fee will be refunded with the attendance fee of the other workshop deducted therefrom.

yCopyrightz

No photos, recording or filming video, etc. will be permitted at the workshops.

yCancellation of the workshopsz

The workshops may be subjected to change or cancellation in the event of a sufficient number of places not being sold.  In this event, your attendance fee will be fully refunded.

yApplication/Inquiryz

STARBLOOM Co., Ltd
Tatsumi bldg. 6F, 607 Higashi Shiokouji-cho, Shimogyo-ku, Kyoto, 600-8216 JAPAN
TEL: +81-75-353-7027
FAX: +81-75-353-7028
E-Mail:
<mailto:miura@starbloom.jp> miura@starbloom.jp
URL: //www.starbloom.jp


Please note the planed content of the workshops may be subject to change.

Workshops for Cognitive Behavior Therapy
By Dr. Christine A. Padesky, Ph.D.

Application Form
Please complete the following.

I wish to attend the following: (Please highlight the item(s) that apply to you and delete the item(s) that do not apply.)

‚PDWorkshop I
‚QD
Workshop II
‚RDParty with Dr. Padesky

Name:

Sex:
Age:

Contact Address:

Telephone No.:
Facsimile No.:
E-mail:

Company Name (School Name/Grade):
Position/Title:

Occupation / Specialized field (Please highlight the items that apply to you and delete the items that do not apply)

1. Psychotherapist (counselor)
2. Doctor
3. Professor/Teacher
4. Nurse
5. Other (                   )

Major/Specialty: Students only (Please highlight the items that apply to you and delete the items that do not apply)

1. Psychology
2. Medicine
3. Nursing Science
4. Pedagogy
5. Study of Social Welfare
6. Other (                   )

How did you find out about these workshops? (Please highlight the items that apply to you and delete the items that do not apply)
1. Direct mail
2. Our website
3. From previously attended workshops
4. Notice in your company, school, etc.
5. Introduced by your acquaintance
6. Study group of Cognitive Behavior Therapy / Yokohama Study group of Cognitive Therapy
7. Other (                   )

Payment (Please highlight the items that apply to you and delete the items that do not apply)
Bank transfer through:
1.   Japan Post Service Co., Ltd.
2.    Bank transfer through Mizuho Bank
3.    Bank transfer through Yokohama Shinkin Bank
4.     Cash registered mail



Cognitive therapy^Cognitive behavioral therapy
Seminar^Training^Workshop