Your Name
Your Email
Where Do You live?
Do you have a professional license & in what discipline?
Where do you work?
List areas of specialization or special interest:
List your level of experience in learning schema therapy:
Check which best applies: I am certified (if so, indicate level below)I am working towards certificationI want to learn about schema therapy but am not interested in certification
If you are already certified, please indicate level:
List at least 3 reasons why you want to join the group and what you hope to gain from it?
