REGISTRATION FORM FOR INTERPERSONAL RELATIONS LAB (IR Lab) 2015
*Registration for OBTC is required in order to be a participant in the IR Lab*
Interpersonal Relations Lab registration must be completed via
PayPal at http://obts.org/irlab
(Please Note: IR Lab space is limited; you will receive confirmation of your enrollment by email upon
receipt of your registration fee and form.)
June 14-17, 2015
University of La Verne
The IR Lab will begin on Sunday 6 pm, 6/14 and will conclude Wednesday 3 15 pm, 6/17.
This form may be word-processed. The boxes will expand as necessary.
******REGISTER and MAKE PAYMENT BY April 1 TO RECEIVE A $50 DISCOUNT*****
Name:
Email address:
Home Address:
Work Address:
Telephones:
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Work
Home
Cell
Anticipated mode of travel:
Anticipated arrival date and time: (Note: The IR Lab begins at 6 pm sharp on
Sunday, June 14 and will end at 10 pm). Please arrive on time and allow enough
time to be rested from your trip. Will you be driving or flying?
Please relate your previous experience with Interpersonal Relations Labs, Tgroups, or any other related personal growth or interpersonal skill workshop:
Please indicate what you hope to gain from the IR Lab experience. Be as specific
as you can:
2
Please provide any other information that you consider relevant to your
participation in the IR Lab, including your MBTI profile, if you know it. If you don’t
know your MBTI profile, do you consider yourself a strong extrovert, a strong
introvert or neither?
In case your name doesn’t give it away, what is your gender?
What is your country of origin? In which country have you resided most of your
life?
How did you hear of the Interpersonal Relations Lab? If through a listserv, please
specify the name of the particular listserv. That information helps us know in
which listservs to publicize the IR Lab.
**Please know that only single room registration is possible during the IR Lab. If you
registered for a double room for obtc, your roommate will join you once obtc begins.
Description
IR Lab Registration Fee with housing
IR Lab Registration Fee with housing and parking
Sun., Mon., and Tues. @$10/day). Please pay for OBTC
conference parking for Wed., Thurs., Fri., and Sat. or for the prior Sat.
(June 13) separately at obtc.org.
Cost on
or
before
April 1
$495
Cost
after
April 1
$495 +
$30 =
$525
$575
$545
3
IR Lab Registration Fee without housing
----------------------------------------------------------------------IR Lab Registration Fee without housing and with
parking Sun., Mon., and Tues. @$10/day. Please pay for
OBTC conference parking for Wed., Thurs., Fri, and Sat. or for the
prior Sat. ( June 13) separately at obtc.org
$374
----------
$424
----------
$374
+$30 =
$404
$454
Please list any dietary restrictions that you have:
Upon completion of the IR Lab Registration Form, please email it to:
Esther Hamilton, the Dean of the IR Lab (esteken@aol.com)
Refund / Cancellation Policy:
The IR Lab provides 100% refund of the IR Lab fee for cancellation by email to
esteken@aol.com by May 1. Because of expenses that the IR Lab will have incurred,
no refunds can be made for cancellations for any reason after that date.
PLEASE NOTE:
**An IR Lab is an educational experience and should not be used as a substitute for
psychotherapy. There may be emotional stress involved in a IR Lab, so participants
must make an informed choice about engaging in this experience and take
responsibility for self-screening.
**Attendance must be discussed with a therapist if the participant is currently in therapy.
If both the IR Lab registrant and the therapist support participation in the IR Lab, then
an endorsement signed by both registrant and therapist must be included with the IR
Lab Registration Form.
**Please read the accompanying IR Lab Hold Harmless Agreement (IR Lab Waiver).
After you arrive on campus but before you can participate in the IR Lab, you will
be required to sign the Agreement and have it witnessed, releasing the IR Lab dean,
facilitators, and administrator and their organizations as well as OBTS and its officers as
well as the University of La Verne and its officers from any liability.
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