Registration form: Isn't this fun? : ) (Note; your information are held confidential, we do not
distribute, sell, or share your personal information)
Please List in details, if any, Previous hypnosis education or hypnosis experience.
Please list in details, if any, previous Medical education
Please list in details, if any, previous psychological or metal health training
Tell us a little more about yourself (no more than 200 words)
What are your reason for taking this class? How do you plan to use
Hypnosis? (no more than 200 words)
deposit. If you are registering very close to the start date, please call
and make sure we still have an opening. If you have problems with
the deposit, or you difficultly sending the deposit, please let us know
and we'll work out your situation.
Prefix (Mr, Ms, Dr., Rev, Count, Gen....)
Last Name
First Name
Telephone # (Day Time)
Telephone # (Night Time)
Fax
Street Number
Street
Apartment #
City
State/Province
Zip/Postal Code
Country
Course Code (or starte date mm/dd/yy)
Occupation
Where did you hear about us?
Preferred Payment Plan (Optional)
Highest level of education (optional)
Comments and questions