BALANCED ENERGIES (Temecula, California)

Holistic & AlternativeTherapy for the Mind, Body & Soul (951) 699-9010

 

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BALANCED ENERGIES
HYPNOSIS APPLICATION FORM

To Register Online, please type in entries below and press "send."  A confirmation of registration will be emailed to you.

Credit cards accepted.  If paying by check, please register online and make check payable to Balanced Energies.  Mail to: Balanced Energies, 44725 Corte Gutierrez, Temecula, CA  92592.   Any questions please call (951) 699-9010.

Admission Requirements:  All applicants must answer all questions on this application form.  You must have a high school diploma or its equipvalent (GED).  You must be approved of for training by Grace de Schepper, Certified Hypnotherapy Instructor, Balanced Energies.

Full Name (for certificate)
E-mail Address
Address Line 1
Address Line 2
City
State, Zip, Country
Home Phone() -
Cell Phone() -
How did you hear about this training?
Currently practicing hypnotherapy?
Current occupation:
Purpose seeking hypnosis training
Any past hypnosis training? (who & when)
Any alternative therapy training?
Any holistic approaches you use?
Educational background:
What special areas of study wanted?
Any intuitive/psychic skills
--- INFO FOR CLASS PAYMENT (below) ---
Class Title
Class Dates
Class Fee
Total Amount Paid Today:
Sending Check (yes or no):
Credit Card (Visa or MasterCard)
Credit Card Number
Credit Card Expiration Date
Refund Policy:  Cancellations must be made at least 7 days prior to class date for a refund, less a $25 processing fee.  Cancellation within 7 days of the class will receive a credit good for 1 year.  $25 service charge on returned checks. 

Call Balanced Energies today at (951) 699-9010