Art & Body Psychotherapy Dubrovnik Summer Workshop
Application Form

Name and surname:
Postal address (Street, City, State, Postal Code, Country):
E-mail address:
Phone or Mobile:
Profession:
Job title:
Employing institution:
If your registration fee is paid by the institution that employs you or any other institution, please provide the following details so that an R1 invoice can be sent to the institution in question:
Name of institution:
Head office (Street, City, State, Postal Code, Country):
OIB/ tax number of the institution: / Institution requires an official offer (answer YES/NO):
E-mail address for submission of invoice:
Phone or mobile contact for invoice-related questions:

If you are a client of Mrs Hannelore Jimenez-Alonso, Mr. John Waterston or Nove igre, please briefly describe the circumstances in English because, as an existing client, you are entitled to a discounted registration fee. (You can attach your photo.)

Date of application:
Have you got any prior experience either with art or body psychotherapy? If yes, please provide a brief description.
How did you find out about the course?
By direct e-mail from the organizers / friend/colleague / Facebook
An announcement or article on a web site/portal / (specify which):
Other (please specify)

A completed application form should be sent by e-mail to
or by fax to +385 (0)1 60 11 699.

If we do not reply to your e-mail within 24 hrs, it means we have not received it. In that case, please give us a call by phone or Skype at the contact details listed in the left section of the next page.

Remember to complete the hotel registration form, thus booking your accommodation!

General information:

·  Workshop is held by Hannelore Jimenez-Alonso, analytically oriented clinical art therapist, and John Waterston, British body psychotherapist.

·  Registration fee covers all workshop materials. During the workshop, there will be no handouts. Participants are free to take notes.

·  You should bring your own mat to the workshop or anything else that feels comfortable to sit or lie down on.

·  The workshop is held from Tuesday 20.8.2013 at 6:00 p.m. until Saturday 24.8.2013 at 12:00 a.m.

·  The breaks will be determined ad hoc by the coach, depending on the processes in the group. There will always be a lunch break and an afternoon break.

·  All participants will receive an attendance certificate.

·  In case of cancellation:

o  by 20.6.2013, we will refund 80% of the registration fee;

o  by 20.7.2013, we will refund 50% of the registration fee;

o  after 20.7.2013, there will be no refund of the registration fee.

Until the start of the workshop, your (paid) place can be reassigned to a person designated by you.

·  In case of an insufficient number of applications, Nove igre d.o.o. retain the right to reschedule the workshop or give a full refund.

Registration and payment of registration fee:

·  Your registration will be confirmed by e-mail as soon as we receive your application and check the availability. If you do not receive a reply to your e-mail within 24 hrs, it means we have not received your application! In that case, please contact us by phone at: +385 (0)91 37 79 745 or Skype: iva.konjevod

·  You will receive confirmation of your registration and information on the total amount of registration fee payable by you (depending on any discount you might be entitled to).

·  Payment must be made within 7 (seven) calendar days of the date of confirmation. If we do not receive your payment within the 7 calendar days, your registration will be nullified. Please bear in mind that an international money transfer usually takes 3 to 5 business days.

For any additional information, please contact us at:

; Iva Konjevod, Mobile: +385 (0)91 37 79 745;
Fax: 01 6525 009; Skype: iva.konjevod; www.noveigre.hr