Registration Form

Your application to attend a workshop will be taken as your agreement to the following declaration

Declaration on Enrolment

I understand that the NSW Psychologists Registration Board will only count my attendance at this workshop towards authorisation as a Psychology supervisor if:

I am currently a fully registered Psychologist in NSW in good standing with the Board (i.e. the Board has not informed
me that there are any problems with my registration) and
I have been a fully registered Psychologist for a minimum of three years (i.e. registered for three years AFTER the period
of provisional registration).
I declare that on the date of this workshop I will meet these requirements.

I understand that it is my responsibility to be sure that I meet these requirements. If I have any doubts as to my eligibility then it is my responsibility to check it with the Board before enrolling in this supervision workshop (workshops@hprb.health.nsw.gov.au).

I understand that workshop attendance before I have been fully registered for 3 years will not be counted by the Board after I have been fully registered for 3 years (i.e. I would be required to attend the workshop again to be eligible for authorisation as a Psychology Supervisor).

If posting your payment please make sure to register on line first to indicate your interest in attending.
All Fields Required

Workshop Dates & Locations Day 1: 9am to 5.00ish Day 2: 9am to 5.30ish. (Both days dependant on how long you take to do the test.)

Psych Rego No. PS	Number only - please do not enter PS or leading zeros
Title
First Name
Last Name
Postal Address
Suburb
Postcode
Preferred Email
Preferred Phone
Payment method	see Payment info below for further details Payment must be received within 7 days or our system automatically cancels your application and you will need to re-apply.
Special dietary needs, comments or questions
Cancellation Policy	Refund of 80% if your vacated place is taken by another psychologist or Refund of 50% if your vacated place cannot be filled by another psychologist No refund if you don't show up on the day without 24 hours notice
Change of Booking	Full transfer of fee to new workshop if your vacated place can be filled by another psychologist or 50% transfer of fee if your vacated place cannot be filled by another psychologist
I have read and agree to the Cancellation and Change of Booking policies and also confirm that I will meet all requirements of the NSW Psychologists Registration Board for attendance by the date of workshop.
Please type YES in box to indicate you agree and confirm you meet Board requirements
After submitted form has been confirmed return here to finalise payment

Payment Information: Two day workshop $380.00 (gst inclusive)

Payment by PayPal	Click here or Click here if you don't have a PayPal account, but would like to know more?
Payment by Credit Card	Click here for details
Payment by Direct Deposit	Bank Account Details Account Name: Viva Wellbeing Pty Ltd BSB:032 267 Account Number: 182 380 (Westpac Bank Leichhardt) Please ensure that you provide identifying information (e.g. Surname and Psych Rego No.) so payment can be attributed to you. We take no responsibility for direct deposits that do not have sufficient identifying information. Please note If your payment does not arrive within 7 days, our system will automatically cancel your application and you will need to re-register. If your employer is funding your training our experience shows that paper work takes much longer than 7 days, it is therefore recommended that you personally make an immediate payment and seek reimbursement from your employer.
Payment by Post	Please make your cheque payable to Viva Wellbeing Pty Ltd and post with application form to: Workshop Manager PO Box 2460 Greenhills NSW 2323 Please note If your payment does not arrive within 7 days our system will automatically cancel your application and you will need to re-register. If your employer is funding your training our experience shows that paper work takes much longer than 7 days, it is therefore recommended that you personally make an immediate payment and seek reimbursement from your employer.