Please complete in full:
Date of Enrolment:
Date of Course:
Select the course you wish to be enrolled in
Intro To Hypnosis Course (2 Day)
Hypnosis Practitioner Certification (2 Day)
Stage Hypnotist Certification (3 Day)
Simply Easy Method License
Weigh Too Easy Method License
Life and Business Coaching Program
NLP Tools For Hypnotists Course
Total Course Fees:
How Will You Pay For Your Course?:
Payment in Full
Date of Birth:
WHERE DID YOU HEAR ABOUT US?
Word of Mouth
CURRENT EMPLOYMENT STATUS
Full time employee
Part time employee
Do you speak a language other than english at home?
No, English Only
Yes, I also speak:
If Yes, how well do you speak English?
Do you consider yourself to have a disability, impairment or long term medical condition?
If Yes, please indicate the areas of disability, impairment or long term medical condition:
Acute Medical Condition
Please provide brief details:
EDUCATION AND TRAINING
Are you a trained hypnotist?
If yes, how long have you been a Hypnotist?
Since leaving school have you completed a qualification?
If yes, please indicate which level qualification:
Bachelor or Higher Degree