Participant Data Form – William Glasser Institute Ireland

Please complete the following form so that we can keep accurate records of your training with WGI.

Name *

First

Last

Your name as entered here will be displayed on your certificates.

Address Line 1 *

e.g., house name, number and street

Address Line 2

e.g., street or district

Town/City *

County/State *

Postal Code

Country *

Email *

Telephone Contact *

Your preferred contact number.

Occupation

Type of Training *

Name of Instructor *

Location of Course *

For example, "Education Centre, Drumcondra". If the course was given online, enter ONLINE.

Starting Date of Course *

End Date of Course *

Please remember to click “SEND TO WGII”. Thank you.