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Mindful Autism Training: Invoiced/Transfer Participant Registration Form

PLEASE NOTE: This form is for participants who have been invoiced or requested a transfer. Use ONLY if this link was emailed to you from Mindful staff. An undesignated registration via this form will not be accepted.

$0.00

In stock

SKU

ASD2022S1REGO

Please provide the full name and date of the Mindful workshop you are reserved to attend

When did you complete the pre-requisite Mindful training? (if applicable)

I am eligible for a subsidised place as I work for

If a MAACC Project Partner

Participant first name

Participant last name

Participant email address

Alternative/backup email address

Participant phone number

Please indicate if you identify as Aboriginal &/or Torres Strait Islander

Location (primary) the participant practices

Participant (primary) profession/discipline

If you selected other

Years of practice

Organisation/Business/Service/Workplace NAME

Organisation/Business/Service/Workplace TYPE

If PUBLIC Victorian CYMHS/CAHMS/AMHS, please specify

Please acknowledge each of the following COVID-19 Safe measures in place at Mindful

I agree to attend only if feeling well and not experiencing COVID-19 symptoms

I will comply with any COVID-19 requirements as advised

Not applicable (online training)

Please provide your postal address for the workshop materials (including post code and state) (if applicable - for ADOS-2/ADI-R training only)

We provide lunch, morning and afternoon tea for our in-person workshops. Please specify any dietary requirements (IMPORTANT NOTE: Allergen safe food/cross contamination cannot be guaranteed. Please advise if Coeliac or other allergies) (if applicable)

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Sold by: Mindful

Contact: mindful-asd@unimelb.edu.au

Phone Number: +613 8344 2000

Instructions:

For product specific queries, contact the email address on the product

For information about upcoming training and frequently asked questions, please visit our website: https://mindful.org.au/asd-training

You have been asked to use this form to complete your workshop registration as your organisation is paying for your attendance at a Mindful ASD workshop. This form allows us to collect the same information that is collected when individual's register and pay for their training.

**If a question is not relevant to you, the workshop(s) you are attending or your organisation, but requires an answer please tick 'Other' or type NA. Thank you.

Mindful is funded by the Victorian Department of Health to train specific cohorts of clinicians in the Victorian public health sector.

The information you provide at registration will be used by authorised staff only for the purposes for which it was collected - enrolment and course administration. Basic contact information will be retained for student alumni management and to inform members of our industry of future training opportunities which may be of interest. All information will be protected against unauthorised access and use. You may access any personal information you have provided to the University, through Mindful, or request removal from our contact list after completion of your course, by contacting us at the mindful-asd@unimelb.edu.au or telephone +61 3 8344 2000. The University of Melbourne is committed to protecting personal information provided by you in accordance with the Privacy and Data Protection Act 2014 (Vic). All information collected by the University is governed by the University’s Privacy Policy. For further information about how the University deals with personal information, please refer to the University’s Privacy Policy or contact the University’s Privacy Officer at privacy-officer@unimelb.edu.au

Cancellation and No Show Policy:
Registered participants who are unable to attend and notify us of this in writing prior to fourteen days before the workshopmay either:
(1) cancel their registration and receive a refund of their payment minus administration fee of 20% or $40, whichever is greater;
(2) transfer their registration once to another eligible participant (no fee);
(3) in some circumstances may be able to transfer their registration once to an equivalent-cost ASD workshop in the same calendar year, if space is available.
Participants who cancel 14 or less business days before the workshop may be permitted to transfer their registration once to another eligible participant (no fee). In exceptional circumstances, please contact Mindful.

Registered participants who are unable to attend and notify us of this in writing prior to fourteen days before the workshop may either:

(1) cancel their registration and receive a refund of their payment minus administration fee of 20% or $40