Grief Certificate Registration Form Please enable JavaScript in your browser to complete this form.Grief Educator Registration The 2025 GE Certificate Program begins September 15, 2025 with live zoom sessions on Sat October 18, November 15, December 13 Times: 12-3pm EST (Toronto time) *Tuition Fees are listed at the bottom of this form. *Additional optional question & answer/integration sessions will be held on zoom on Wednesdays November 5 and December 3, 7-8:30pm EST (Toronto Time) To join our GE 2025 program, please complete this Registration Form fully. **Please review the refund policies below before submitting your registration. Note that live zoom sessions are not recorded. *Note: ITM reserves the right to cancel a registration based on insufficient prior training in end of life care. Name *FirstLastGender Identity *Pronouns *Email *Phone *Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryEducational Background *Related Training: this program is designed for those with previous experience in end of life care - please confirm your experience - ie. End of Life Doula, Therapist, Healthcare professional *If you have completed an End of Life Doula program, please list the program and year completed *Employment History *Additional Info (that may help us to support you in the training (incl mental/physical conditions) *Personal Reflection of Intent * Please discuss the process and experiences that have led to your interest in the GBE Program. *Declaration *AgreedBy checking this box and submitting this application/registration I acknowledge and agree to the following: *All terms, courses, dates, policies are subject to change without notice. *All information filed during this application process become part of your permanent, confidential record. Declaration: I hereby attest that all statements on this application form are true and complete in all respects, and no relevant information has been withheld. I agree and abide by the policies, rules and regulations of the Institute of Traditional Medicine.Refund Policies *AgreedBy checking this box and submitting this registration I acknowledge and agree to the following Refund Policies & Cancellations For any students/participants who wish to withdraw or cancel enrolment in the program or any classes, formal written notice must be given to the the Institute via email to info@itmworld.org. Students are not eligible for any refunds without formal written notice. Transferring enrolment to a future year, or another person is also not possible. Refunds for withdrawals or cancellations prior to the commencement of the program: A) Full tuition is refunded less a $250 administration fee if notice is received within 30 days of acceptance to the program and at least 120 calendar days before the program start date. B) Subject to A, the full tuition is refunded less 50%, if notice is received less than 120 and more than 90 calendar days before the commencement of the program. C) Subject to A, there are no refunds 90 calendar days before the commencement of the program nor after the program begins. (Note: if you register less than 90 calendar days before the commencement of the program, you will not receive a refund of any amount if you withdraw).Waiver *AgreedBy checking this box and submitting this application/registration I acknowledge and agree to the following: I, the participant release the organizers of the training and their directors, sponsors, employees and agents from any liability for death, disability, injury and property damage. The participant acknowledges the risks involved with participating in the program, and assumes all responsibility, and waives any claims they may have. The participant agrees that they have informed the organizers of any relevant medical (health or mental) concerns that they may have. *I am acknowledging that I have read, understand and agree to the refund and cancellation policies and waiver, and understand and agree that a default in my tuition obligations for this program will be submitted to a third party and may affect my credit rating.Attendance Agreement *AgreedBy checking this box I acknowledge and agree to the following: I affirm that I am fully prepared at this time to commit to this training program. I, the participant am aware of and agree that to receive a certificate for this training I am responsible for reviewing the materials of the course, completing the assignments and attending all required live zoom sessions. If for any reason I miss any of the live sessions (more than 15 minutes of any live session) - I will not be eligible for the certificate. If a live session (more than 15 minutes) is missed, I am required to re-enrol and pay for the missed live session the following year only. If I miss more than one full module live session, re-enrolment and re-payment of the full program is required for issuing of a certificate. There are no exceptions to this policy. *Live Sessions are NOT recorded. I understand that the program requires the use of a computer and a stable internet connection for the live virtual sessions, and that continually disconnecting from the live virtual sessions and not being on camera will result in being marked absent.Access to Program & Materials *AgreedBy checking this box I acknowledge and agree to the following: I affirm that I am fully aware and in agreement that I have access to the program materials for the length of the program and am responsible for downloading the documents/manuals/links within this timeframe. If I fail to do so, I am aware that I will not have access to the documents/materials once the program ends, with no exceptions to this policy. I am aware that videos are not downloadable and only available for the duration of the program.Tuition *No Longer Avail Early Registration by July 15 ($550)No Longer Avail CEOLC Graduate Discount by July 15 ($500)Regular - After July 15 ($700)Tuition is in Canadian Funds. Plus HST.Total *$0.00Tuition FeePayment Information *CardName on CardSubmit