NGHREGISTRATION APPLICATION – HYPNOSIS TRAINING

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


 NAME:                                                                            DATE:

ADDRESS:

EMAIL:

HOME PHONE:
CELL PHONE:
WORK PHONE:

AGE:                                                GENDER:

OCCUPATION:

HIGHEST LEVEL OF EDUCATION, TRAINING AND EXPERIENCE:

 

REASON FOR WANTING THIS TRAINING:
 

DO YOU AGREE TO COMPLY WITH THE NGH STANDARDS OF PRACTICE AND CODE OF ETHICS? _______        http://www.ngh.net/Downloads/CodeEthicsStandards.pdf

  ____SUMMER TRAINING BEGINS May 2012

 ____WINTER TRAINING BEGINS September 2012

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

                                                                 

                                                                      Signature:_____________________________

Tuition = $1,700 for Training and materials;
Registration Fee of $200 to hold your place in the class - Total $1900.  Receive discount for payment in full. ___.

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

 

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HYPNOSIS IN ARLINGTON, VIRGINIA 22207
Serving Virginia, Maryland, Washington, D.C.