Note: an interview with Instructor Mary Elizabeth Raines is required before acceptance into the hypnosis certification program. Please print and fill out the below form only if you have already completed your interview. Mail completed form, together with your deposit, to the address listed at the bottom of the page.


REGISTRATION FORM
ACADEMY FOR PROFESSIONAL HYPNOSIS TRAINING

 

FULL NAME (Please Print)_________________________________________________________

NAME BY WHICH YOU WOULD LIKE TO BE CALLED___________________________________________
 

MAILING ADDRESS ____________________________________________________________  

_______________________________________________________________________  

_______________________________________________________________________

TELEPHONE (HOME)__________________(WORK)____________________(CELL)_____________

E-MAIL (Will be used only for school communications)________________________________________

DATE OF BIRTH ____________________________________


CURRENT PROFESSION_________________________________________________________

EDUCATION OR OTHER TRAINING YOU HAVE HAD WHICH MIGHT BE PERTINENT TO HYPNOSIS:

______________________________________________________________________

BRIEFLY DESCRIBE YOUR INTEREST IN STUDYING HYPNOSIS:

______________________________________________________________________

______________________________________________________________________

PLEASE SHARE ANY PERSONAL CONDITIONS INCLUDING MEDICAL HISTORY/SERIOUS ALLERGIES/OTHER CIRCUMSTANCES OF WHICH WE NEED TO BE AWARE:

_____________________________________________________________________________________________________________

NAME, PHONE NO. & EMAIL OF EMERGENCY CONTACT

_____________________________________________________________________________________________________________

CLICK HERE FOR TERMS AND CONDITIONS (takes you to another page)

BY SIGNING BELOW, I DECLARE THAT I HAVE READ, UNDERSTAND, AND AGREE TO ALL TERMS AND CONDITIONS.

 

 

________________________________________________________________________

         Your Name/Date

DEPOSIT ENCLOSED IN THE AMOUNT OF: _______________
($700 minimum; balance due on the first day of class)

___I request membership in the National Guild of Hypnotists

__I opt out of membership in the National Guild of Hypnotists

Thank you! We look forward to meeting you soon!

Please make out check to M. E. RAINES and mail together with this form to:

Academy for Professional Hypnosis Training
PO Box 1059
Sedona, AZ 86339


REFUND AND DISCOUNT POLICIES:

Discounts: Tuition discounts are only applicable if deposit has been postmarked by due date and balance is paid before or on the first day of class. Discount for bringing a friend is only applicable if both parties enroll in and pay for entire three-workshop course. In the event of any delay in payment, all discounts will be null and void.

Refund policies: a minimum deposit of $700 is required to enroll and to be eligible for early enrollment discounts. The deposit amount, minus a $45 bookkeeping fee, is completely refundable up until six weeks before the beginning of class. From four to six weeks, $500 of this amount is refundable. From four weeks to two weeks, refunds will be given for any amount in excess of $400; the remainder is non-refundable, however, $350 of this amount may be applied to another Academy for Professional Hypnosis Training program if the cancellation is due to a verifiable medical or family emergency (legal documentation required). Because nonrefundable reservations will be made for instructors/staff, memberships paid for and supplies ordered, there will be no refunds from two weeks to the start of class. After class begins, there will be no refunds.

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