Hypnosis Training Application - Certified Hypnosis Training

Name *

First

Last

Email *

Primary Phone# *

Full Mailing Address *

Emergency Contact Phone# *

Age Bracket *

18 to 25
26 to 35
36 to 50
+ 50 years old

What is your experience with hypnosis? *

I have zero experience
I have seen hypnosis on tv
I have been to a stage hypnosis show
I have been hypnotized a less than 3 times
I have been hypnotized more than 3 times
I am already a level 1 hypnotist
I am already an advanced level hypnotist

What would you use hypnosis for? *

personal growth & development
a form of self meditation
to help family/friends overcome their challenges
to help anyone with any problems they have
to make money

Do you hold a Professional Degree? *

Which course are you interested in taking? *

100 Hour Full Hypnotist Course
40 Hour Basic Hypnotist Certification - only
60 Hour Advanced Hypnotist Certification - only
Rejuvenation Coach Certification - only
Hypnotist and Coaching Certifications

What Platform do you prefer to utilize? *

How soon are you wanting to begin? *

I understand that I am required to maintain a minimum of a 90% attendance rating. I am aware that my participation in class is equally as important as my attendance. I agree to be an involved member of the group discussions and will do any homework assignments given. I realize that failure to do any of the above may result in not passing the course. In the event that I do not pass the course, I understand that I will have to re-take the course within 3 months - or within one of the following three course availabilities - whichever comes first, before I will be eligible to proceed into the Basic Certification course. Furthermore, I understand that any and all information regarding refund policies will be provided to me, in writing, at the time that payment is arranged. *

I agree
I disagree

Choice of Payment *

Basic Course: 1295.00 - 300.00 discount for payment in full= balance of $995
Basic Course: 3 payments of $431.67
Advanced Course (must already have basic certification): 1499.00 - 300.00 pif discount = balance of $1195.00
Advanced Course (must already have basic certification): 6 payments of $249.84
Full Course (basic + adv): 2794.00 - 700.00.00 discount for payment in full = balance of $2094.00
Full Course (basic + adv): 8 payments of $349.25
Rejuvenation Specialty Course - pif $479.00
Rejuvenation Specialty Course: 3 payments of $160.67
ADD-ON Rejuvenation Specialty to Any Hypnosis Course: $149.00 when paid in full with associated tution fee

PIF: when you pay in full, you receive a hefty discount ................................... Non-negotiable Terms of Payments: Dependent upon automated payment authorization via credit card withdrawal. Note - certification will not be released until payment has been received in full. If at any time during the payment process a payment is rejected or returned for insufficient fund, payment will be attempted a 2nd time. If payment is then not processed, you will be automatically removed from the program until payments are caught up to date. Additionally, if you choose a payment option, you have the ability to pay off the balance early with no "additional" fees or discounts offered. *further terms and conditions will be explained with invoice for payment.

Signature *

Date of Application