All information given will be treated with the utmost confidentiality, and
complete discretion will be exercised when contacting you.

Please note that the DSGA is based, and convenes, in London only.

    Note: Fields in red must be completed.
Name:
  
Address:
  
Postcode:
  
Telephone:
  
E-mail address:
  
Occupation:  
I am interested in: (please tick)  

The Support Groups
The Shyness and Social Anxiety Programme
The Low Self-Esteem Programme
The Personal Relationship Programme
Individual Therapy

I have been/am in therapy
and/or
I am interested in the DSGA because:
(please give details)

 
I have had experience relevant to convener training:
(please state qualifications)
  
   

 

 

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