Registration form: Isn't this fun? : ) (Note; your information are held confidential, we do not
distribute, sell, or share your personal information)
Please List in details, if any, Previous hypnosis education or hypnosis experience.
Please list in details, if any, previous Medical education
Please list in details, if any, previous psychological or metal health training
Tell us a little more about yourself (no more than 200 words)
What are your reason for taking this class? How do you plan to use
Hypnosis? (no more than 200 words)
Prefix (Mr, Ms, Dr., Rev, Count, Gen....)
Last Name
First Name
Telephone # (Day Time)
Telephone # (Night Time)
Street Number
Apartment #
Zip/Postal Code
Course Code (or starte date mm/dd/yy)
Where did you hear about us?
Preferred Payment Plan (Optional)
Highest level of education (optional)
Comments and questions