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NGH HYPNOSIS CERTIFICATION TRAINING

 

  • REGISTRATION APPLICATION

    Hypnosis & Emotional Freedom, 2525 N. Wakefield Street, Arlington, VA 22207
    Phone:  (703) 346-4606          Email:  hypnosis3@gmail.com


    Training is held on WEEKENDS

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    REGISTRATION FORM THAT CAN BE COPIED AND PASTED IN A DOCUMENT AND EMAILED BACK.

    NGH HYPNOSIS CERTIFICATION TRAINING - REGISTRATION FORM

    Hypnosis & Emotional Freedom Center
    2525 N. Wakefield Street, Arlington, Va  22207
    (703) 346 4606        Hypnosis3@Gmail.Com        Www.Hypnosisva.Com

    NAME:

     

    DATE:

    ADDRESS:

    DOB:

    Age:

    Sex: M F

    CELL PHONE:

    HOME PHONE:

    EMAIL:

     

     

     

     FAMILY: 

    No. of Children:

    Siblings:

    Spouse/Significant Other:

     

     

     

     

    OCCUPATION:

    EDUCATION:

    EMPLOYER:

    Has anyone tried to hypnotize you?

    For what reason?

    Do you believe you were hypnotized?

    Other alternative interests, modalities or trainings:

    Reasons for wanting this training:

    Have you ever been convicted of a felony?  

    Do you agree to comply with the NGH Standards of Practice and Code of Ethics? 
    http://www.ngh.net/Downloads/CodeEthicsStandards.pdf

     

    HOW TO REGISTER

    Please return this form along with the NGH Materials Fee to hold your place in the class.

    TUITION  - PAYMENT PLANS - DISCOUNTS

    TUITION 
    $1,700 – Tuition
      + 200 – NGH Registration & Materials Fee (Manuals, DVDs, CDs, Supportive Materials, NGH Membership, etc..)
    $1,900 – Total

    DISCOUNT:
    $100 Discount as a former or current client at Hypnosis & Emotional Freedom

    PAYMENT OPTIONS:  Credit Card  -  Cash  -   Personal Check

    OPTIONAL PAYMENT PLANS of 2 or 3 Payments:  
    I am making Full Payment now.  _____       My Payment Plan Will Be Made In ____ Installments.

     

    IN CASE OF EMERGENCY

    Name of local friend or relative:

    Relationship:

    Home phone no.:

    Work phone no.:

    The above information is true to the best of my knowledge.

     

     

    Signature:

    Date: