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2015 – 2016 APPLICATION FORM

PROGRAM DATES (All sessions should be attended):

November 18 – 22, 2015 (Wednesday – Sunday)

January 13 – 17, 2016 (Wednesday – Sunday)

April 6 – 10, 2016 (Wednesday – Sunday)

June 22 – 26, 2016 (Wednesday – Sunday)

**Please fill the information below for applying to Gestalt Coaching Program in Istanbul. All fields marked with "*" is mandatory.**

Name *

Last Name *

Email *

Mobile Phone *

Other Phone

EDUCATION (Last three schools you graduated, graduation year and field of study) *

Other training completed - Gestalt, Coaching, etc (Please list name of program, year, duration, leaders)

Check box if you have any training in Gestalt before.

Work Experience (Please list last three positions held, with dates and organizations)

A $ 950.- + VAT nonrefundable registration fee must be paid. No registration is complete without payment.

I will deposit the amount in GCC's bank account (Please contact us for details)

I will pay in cash in GCC's offices

PAYMENT (Choose your prefered method below by checking the box next to it)

Program tuition fee is $ 9,950 + VAT (including nonrefundable registration fee).

If payment is received in full before program begins, $450 will be waived and total payment will be $9,500 + VAT

WE OFFER A 6 MONTH – PAYMENT PLAN: $ 950(nonrefundable registation fee) + $ 3,000 + VAT due at registration -- $ 1,000+VAT x 6 installments due at each of Jan 1, Feb 1, Mar 1, Apr 1, May 1 and June 1.

After completing this form, please press the "SUBMIT" button below. Submitting this form does not complete the registration process. No registration is final before submitting the registration fee.

We will contact you with payment information.

Please contact our offices for any other information thru email at seda@marefidelis.com or by calling +90 212 325 98 50.