November 21, 2015 Life Story™ Board Training Workshop Registration Contact Information and Background LSB Basic Workshop Saturday, November 21, 2015. ($175. CND + GST)• light lunch is provided (or BYO, there is a kitchenette)• includes digital copies of background materials and weblinks• # of CECs for combined Workshop and Aftercare: 15 CCPA Continuing Education Credits • Workshop is limited to maximum 8 participants. Payment Options:Payments may be made via PayPal, credit card online, or by cheque / credit card at time of workshop.Once you register, I will email you an invoice which includes a link for online payment. Please click on it to review your invoice details and process your payment. if you prefer to pay by cheque, your invoice will include instructions for filling out and submitting it. Please email Rob Chase to confirm your invoice and contact details, and your payment mailing date. Purchase of the Life Story Board™ ToolkitSpecial 30% workshop discount $245 +GST (regular price $350 )Optional: LSB Kits can be purchased at the discount price the after workshop; however shipping charges may apply.LSB Kit Purchase includes invitation to join Vidaview's ‘LSB Introduction' Basecamp project to access resources and updates, share questions and observations in a secure private discussion forum. After Care Package $200 for up to 4 hours of one-on-one sessions with a Life Story Board™ TrainerThe 'After Care' package is a self-directed 4-step course for basic LSB literacy, consisting of reading materials, case study viewing, practice exercises, and LSB session rehearsal, usually done over a 4 week period.The LSB trainer / supervisor facilitates as you familiarize to the LSB system, customize your own kit, and practice layouts and scenarios preparatory to use with clients.Photos of LSB layouts are posted to the secure private LSB Aftercare discussion forum to share questions, comments and experiences. Question Title * 1. Please provide the following information. Please note: 'Name' 'City/Town' 'Country' and 'Email Address' are REQUIRED fields and must be completed before you will be able to proceed to the next page. Name: * Organization: Address 1: City/Town: State/Province: ZIP/Postal Code: Country: Email Address: * Phone Number: Question Title * 2. Please describe your experience and training background. Degrees: Certification: Licensure: Practice Approach, Theory, or School: Years in Practice: Other Relevant Experience: Question Title * 3. Please describe your type of practice and clinical/community setting. Check boxes that apply and describe in the comment box. Children Family Youth Adults Elderly First Nations/ Aboriginal/ Metis Multicultural Private Practice Private Practice Children Private Practice Family Private Practice Youth Private Practice Adults Private Practice Elderly Private Practice First Nations/ Aboriginal/ Metis Private Practice Multicultural In a Primary Health Care Organization In a Primary Health Care Organization Children In a Primary Health Care Organization Family In a Primary Health Care Organization Youth In a Primary Health Care Organization Adults In a Primary Health Care Organization Elderly In a Primary Health Care Organization First Nations/ Aboriginal/ Metis In a Primary Health Care Organization Multicultural In a Mental Health Agency In a Mental Health Agency Children In a Mental Health Agency Family In a Mental Health Agency Youth In a Mental Health Agency Adults In a Mental Health Agency Elderly In a Mental Health Agency First Nations/ Aboriginal/ Metis In a Mental Health Agency Multicultural Detention/Prison Services Detention/Prison Services Children Detention/Prison Services Family Detention/Prison Services Youth Detention/Prison Services Adults Detention/Prison Services Elderly Detention/Prison Services First Nations/ Aboriginal/ Metis Detention/Prison Services Multicultural In a Community Program In a Community Program Children In a Community Program Family In a Community Program Youth In a Community Program Adults In a Community Program Elderly In a Community Program First Nations/ Aboriginal/ Metis In a Community Program Multicultural Child and Family Services Child and Family Services Children Child and Family Services Family Child and Family Services Youth Child and Family Services Adults Child and Family Services Elderly Child and Family Services First Nations/ Aboriginal/ Metis Child and Family Services Multicultural Other Other Children Other Family Other Youth Other Adults Other Elderly Other First Nations/ Aboriginal/ Metis Other Multicultural If 'Other', please specify Next