Registration Form | Art Therapy Gestalt

First Name

Last Name

Email

Phone Number Include internationalcodes if outside Australia

Country

City

Training, workshops etc. that you are interested in receiving information

Membership type

Silver member early bird $25

Silver member $35

Gold Member early bird $40

Gold Member $60

I would like to pay my membership by

Credit Card Paypal in the membership info

I have already paid

Bank Transfer Only Australia

Once we will receive your payment you will receive your Member card & number. Participating in this CLUB means you accept all the terms and conditions. Read info here www.arttherapygestalt.com

I agree

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