Workshop Presenters Training Application Form

Name(Required)

First Last

Phone

Email(Required)

Enter Email Confirm Email

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Please detail the Advanced Trainings you have attended with dates and name of trainer

I intend to deliver the workshop …

on my own or with another participant of the training

with my non – imago therapist partner

Name of partner(Required)

First Last

Email of partner(Required)

Enter Email Confirm Email

Dates for the training. Please note that we really need you to be flexible with the group you are allocated. This will keep the number of couples presenting together and the number of individuals balanced across the two groups.(Required)

I confirm that I would be available for all of the dates in both groups

I can only do the dates for group 1

I can only do the dates for group 2

Confirmation(Required)

I understand that I do not have a place on the course until I have paid the deposit and signed the business contract for the training.

Transferring(Required)

I understand that once I accept a place on the training I cannot defer the training or be transferred to a different group

Completion of Advanced Trainings(Required)

I commit to attending all the Advanced Trainings I need in order to become an Advanced Imago Therapist and understand that I will not qualify as a Workshop Presenter (or be able to deliver workshops outside the training period) until I have done this

Deposit(Required)

I understand that the deposit of £300 is non-refundable and the full fee is non-refundable two months before the start of the course

Name

This field is for validation purposes and should be left unchanged.

Workshop Presenters Training Application Form

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