Text Box: Gestalt with Groups Application Form (please print ) Name Address ______ Suburb postcode Telephone: Home Work Facsimile email Please tick appropriate amount I enclose the deposit of $80 I enclose the full payment of $320 Send application and payment to: Illawarra Gestalt Centre, PO Box 177, WOLLONGONG, NSW 2520. Make all cheques payable to: Illawarra Gestalt Centr ABN 73 355 220 037 Refund Policy Once applicants are accepted into the course, the final payment is due 14 days before the commencement of the training program. Any deposit or prepayment is subject to a cancellation fee of $25 dollars if notice is given before 14 days of the program commencing. No refunds will be provided after that. Further enquires to Jenny O’Neill: phone/fax (02) 4228 0132 mobile: 0409 280 247