Application

To participate in the workshop, please first submit this form containing some information on your person, and afterwards proceed to the payment section by clicking the link 'fees'.

Application Form:

• First Name, Last Name:
  
• Address:
  
• Phone (incl. Country- and City Code):
  
• Fax:
  
• eMail:
  
•   Male     Female
• What academic degree did you earn? In what field?
  
• Are you a member of the ISCA?
    Yes     No
• Are you licensed to practice psychotherapy or psychological counseling in your country?
    Yes     No
• If 'yes', what license do you have (include number)?
  
• If 'no', how do you plan on using your skills in family constellations?
  
• Do you have any mental or physical problems, which could affect your participation? If yes, which?
  
• In what setting(s) do you work? For example: private psychotherapeutic practice, psychiatric hospital, self-employed organizational development:
  
• We need your help to assist us in placing you together with persons of similar experience and learning needs.
  
• On how many days have you been a participant in a Family or Organizational Constellation Course or workshop?
  
• On how many days have you participated in a training course in Family or Organizational Constellations?
  
• If you already have led Family Constellations, approximately how many?
  
• On how many days have you led training in Family or Organizational constellations
  
• Preferred accomodation (includes meals):
•   Single Room at Cloister Bernried (500 €/person)
  
•   Double Room at Cloister Bernried (450 €/person)
•   Single hotel room (5 minutes walk): min. € 810.00
•   Double hotel room (10 minutes walk): min. € 760.00 / person
• If your first choice is not available, do you prefer a higher category or a lower category?
    higher     lower
• Please note that the prices for hotel room include meals at Cloister Bernried
  
  I understand that the workshop for which I am applying does not qualify me to practice psychotherapy and I agree to limit my use of the material presented to those areas and clients for which I am qualified. I declare that the information I have given is true and complete to the best of my knowledge. I understand that the workshop may involve intense emotional experiences and I accept full responsibility for my participation and any consequences it may have for me.
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