Registration form

Three simple step to complete your registration

1. Select your language:

2. Fill the form:
(data in blue are compulsory)

Select a program:
Training for Gestalt Supervisors - Milano, Siracusa 2017-2019

Gestalt Therapy Approach to Psychopathology and Contemporary Disturbances - Roma, Milano, Siracusa 2018-2020

Name:

Last Name:

Email:

Postal Address:

Country:
Phone: Cel phone :

Main occupation:

Degree

Place of birth a:

Date of birth:
gg: mm: aaaa:

I have been trained in gestalt therapy with:

Personal interest in attending the training:

I want to register for this international course
I want to ask for information

I hereby authorize the use of my personal details solely for circulation within the company in relation to the Italian Legislative Decree n° 196/2003
I authorize
I don't authorize

3. Send your registration form