Returning Trainees and Making a Payment – Weekend Training Program

FOR ALL RETURNING TRAINEES: To pay the training deposit or to make a full or partial tuition payment via PayPal, please provide the information requested below.

FOR NEW APPLICANTS ONLY: Please complete this weekend training application form, submit, and pay the initial deposit online via PayPal by providing the information requested below.

FOR SCHOLARSHIP APPLICATIONS: Please complete and submit the scholarship application here.

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Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Occupation

Professional License

License #

Weekend Training Program

Deposit Only - $500.00

Full Tuition - $2,150.00

Weekend Training Program - Other Amount

Total

Phone

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Faculty

Armin Baier
L.C.S.W., J.D.

Ren Barnebey
M.F.T.

Christine Campbell
M.F.T., A.T.R.

Lynne Jacobs
Ph.D.

Michelle Seely
M.F.T.

Gary Yontef
Ph.D., A.B.P.P.

Pacific Gestalt Institute

1800 Fairburn Ave
Suite 103
Los Angeles, CA 90025
Tel: 323-418-2648