Returning Trainees and Making a Payment – Weekend Training Program

FOR ALL RETURNING TRAINEES: Please contact us at pacificgestaltinstitute@gmail.com to submit your deposit.

FOR NEW APPLICANTS ONLY: Please complete this weekend training application form.

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 - $2,300.00

Weekend Training Program - Other Amount

Total

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

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

1800 Fairburn Ave
Suite 103
Los Angeles, CA 90025
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