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 - TO BE ANNOUNCED ______  10AM to 3PM Registering for:  LEVEL II (2-Day Wksp.)- Weekend of  TO BE ANNOUNCED_____10AM to 3:00PM PAYMENT BY (Check; Credit Card; other):  ___________________