Expression of Interest: 4-Day Intergenerational Couple Therapy Workshop 2026 (Batch 2)

Important: This form is strictly for expression of interest. No payment is required at this stage. Selected participants will be contacted by the trainer via call or email for eligibility screening, as we aim to create a cohesive and effective learning cohort.

Once confirmed, participants will be invited to complete the payment process.

Targeted audience:
Mental health professionals, students, and affiliates across disciplines (counsellors, clinical psychologists, psychiatrists, social workers and MFTs) that works directly with couples.

Payment Method: Online banking transfer or direct bank transfer

Payment Structure:

	Early Bird	Normal rate
Individual	RM2200 Deposit: RM1000 Remaining balance: Rm1200 (before 30 June 2026)	RM2400 Deposit: RM1000 Remaining balance: RM1400 (before 31 July 2026)
Group of 3	RM 6000/ group (RM2000/pax) Deposit: RM3000 Remaining balance: RM3000 (before 30 June 2026)	RM 6600/group (RM2200/pax) Deposit: RM3000 Remaining balance: RM3600 (before 31 July 2026)

Contact Us: event@andolfi.my

Terms and Condition:
Andolfi Family Therapy Centre (Malaysia) reserves the right to amend, change, or update any part of the event details—including the program schedule, speakers, venue, policies, and selection of participants—without prior notice, if necessary. All changes will be communicated to registered participants as soon as possible.

No Refund Policy
All payments made for this workshop are non-refundable. However, you may transfer your paid slot to another participant by notifying us via email no later than 21 days before the event.Please ensure you have read and understood the workshop details before registering.

Cancellation Policy
In the unlikely event that the workshop is cancelled by the organizer, a full refund will be issued to the registered participant.

Non-Exchangeable Policy
Workshop fees are strictly non-exchangeable and cannot be transferred to future events or workshops.

Please select your title:*

Name *

First NameLast Name

Email (preferably gmail)*

example@example.com

Address*

Street ddress

Street Address Line 2

CityState / Province

Country

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Your occupation/profession*

Your Current Organization / Workplace*

How many years of experience you have working with couples?*

What is your highest qualification? (Examples: Masters in Counselling, Diploma etc) *

What is your current professional license or registration (if any) with any professional body?*

Licensed and Registered Counsellor – Lembaga Kaunselor Malaysia (LKM)Registered Clinical Psychologist – Malaysian Society of Clinical Psychology (MSCP)Psychiatrist - National Specialist Register (NSR)Registered Psychologist – Malaysian Psychological Association (PSIMA)Registered Social Worker – Malaysian Association of Social Workers (MASW)Licensed Lawyer – Malaysian Bar CouncilI do not have any of the aboveOther

Please upload your latest CV*

Write a short paragraph on why you want to join this course. (Approximately 500 words)*

I hereby acknowledge that I may be contacted for a brief call or interview by the trainer to assess my eligibility for participation*

I acknowledge.

Andolfi Family Therapy Centre (Malaysia) reserves the right to decline applications or participation based on eligibility criteria or other considerations, in order to maintain the quality and suitability of the workshop experience*

I acknowledge.

By hitting submit and clicking "yes", you consent to Andolfi Family Therapy Centre collecting and using your personal data for workshop administration, event updates, and related communications via email or WhatsApp.*

Yes.

Your e-signature*

Today's date*

Date