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

Registering for Training Session Beginning:  January 17, 2009 ______ OR September 12, 2009_____

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

                                                                 

                                                                      Signature:_____________________________

NGH Certification Tuition = $1750.00
Plan #1:  Full Tuition of $1,750 ten days prior to class date.  A minimum deposit of $200 is required to hold your place in this limited size class.
Plan #2:  Full Tuition of $1,875 in THREE MONTHLY PAYMENTS of $625.  A minimum deposit of $200 required to hold your place in this limited size class.

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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