REGISTRATION APPLICATION – EFT WORKSHOP

 Hypnosis & Emotional Freedom, 2525 N. Wakefield Street, Arlington, VA 22207
 Phone:  (703) 346-4606       Fax: (703) 524-2118    Email: jane@hypnosisva.com

DATE:  _______________________
 NAME:

ADDRESS:

EMAIL:

HOME PHONE:
CELL PHONE:
WORK PHONE:

AGE:

GENDER:

OCCUPATION:

HIGHEST LEVEL OF EDUCATION, TRAINING AND EXPERIENCE:

 

REASON FOR WANTING THIS TRAINING:
 

Registering for:  LEVEL I_____ >>>November 15, 2008___  OR  February 7, 2009___

Registering for:  LEVEL II (2-Day Wksp.)_____>>>Jan. 10 & 11____ OR March 21 & 22____

PAYMENT WILL BE MADE BY (Check; Credit Card; other):  ___________________

                                                                 

                                                                      Signature:_____________________________

EFT Workshop Level I = $125.00
(Discount offered to former clients)
EFT Workshop Level II (2-Day Sesssion) - $250.00
                                                   

Make check payable to:   J. A. Buckman
 You may register and pay by credit card (VISA or MASTER) by phone (703 346 4606),
by Fax (703-524-2118), or by writing to:

Jane Buckman, Hypnosis & Emotional Freedom, 2525 N. Wakefield Street, Arlington, VA  22207

 

NOTE:  TO SEND YOUR APPLICATION BY EMAIL, JUST COPY AND PAST THE FORM AND SEND AS AN EMAIL.


                                          

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EFT  IN ARLINGTON, VIRGINIA
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