Mental Images - Application

Firstname*

Prefix

Lastname*

F/M/X*

FMX

Address*

Postalcode*

City*

Telephone/Mobile*

E-mail private*

E-mail business*

Date of birth (for certificate)*

Dietary requirements

Company*

Job title*

Highest education* 

The investment in this masterclass is € 2.795 including catering study materials.
The course fee is free from VAT. Members of the AUV and Alumni of AAGS/ UvA Academy receive a 10% discount.

Yes, I am an alumnus of the UvA/ UvA Academy

—Please choose an option—I am a member of the AUVI have participated in an AAGS/UvA Academy programI am a UvA employee

Billing address*

Billing e-mail address*

Reference

What learning goals do you want to reach by participating in this program?*

How did you learn about this program?*

—Please choose an option—I participated in another AAGS/UvA Academy programFacebookGoogleInstagramLinkedInUvA Academy newsletterUvA Alumninewsletter/SPUIThrough a collega/acquaintanceWebsite UvA Academy/UvAOther

Other specifics

We care about your privacy. If you have questions about our policy, please visit the link below. If you have questions that are not answered there, feel free to contact us: https://www.uva.nl/home/disclaimers/privacy

Application terms*

By clicking this option you agree to the conditions of registration
Conditions of Registration