Istituto di Gestalt HCC Italy

Registration form

First name

Last name

Email

Phone

Privacy note: the following data are important to issue the final certificate (if you don't want a final certificate you can just insert a random value).

Place of birth

Date of birth (dd/mm/aaaa)

Address

ZIP code

City, State

Country

If your Country is not in the list please contact info@gestalt.it

Privacy note: the following data are important in order to verify previous training requirements.

Main occupation

Degree

I trained in Gestalt therapy with (or in which Institute)

Personal interest in attending the seminar

Professional ethics

I declare that I am a psychotherapist, trainee, researcher, or professional with an interest in Gestalt therapy and related fields. I commit to respecting the ethical principles of professional conduct, confidentiality, and responsibility in both clinical and research contexts. I agree not to disclose any personal, clinical, or sensitive material that may be shared during the conference sessions, discussions, or workshops, and to use such material exclusively for educational and scientific purposes in accordance with ethical standards.
Please select one:
I am a psychotherapist, trainee, or professional in the field
I am not a psychotherapist or trainee but I participate as a researcher, student, or interested attendee

By sending this form, I agree to the privacy policy

You can pay with your credit/debit card (Visa, Mastercard, American Express,...).
If you wish, you can use Apple Pay, Google Pay, Bancontact, EPS, Giropay, iDeal, Przelewy24.

Do you need an invoice? After payment is complete, you will receive a confirmation email with instructions to request an invoice.

Gestalt Therapy Research Conference

Cooperation among clinicians and research groups