Form Page: regi

Revised 2023-05-16

Registration Form for Gestalt Practitioners in Organization (GPO)

Personal Data:

Last Name:

First Name:

Street Adress:

Zip Code and Place/Town:

Country:

When accredited, list me on the EAGT GPO website.

Name,email and above address

Name, email and limited info below

Do not list me

Limited info Specify
(max 100 char):

WebSite:

Email:

Comment:

I declare that the information in this file is accurate

I agree with the rules and steps of the process of an individual GPO accreditation, as formulated in the GPO Handbook.

I register for an individual GPO accreditation.

I accept all costs related to this accreditation. The non-refundable fee is €150,00.

I have read and agree to the privacy statement of the EAGT.

I accept that EAGT stores this information during my membership, and shares my email address for invoicing purposes. (With Bank or PayPal.) In EAGT only officers or employees of the organisation can access my data.