[email protected](415)6992574
577SoquelAve.SantaCruz,CA95062
MEDICALHYPNOTHERAPYTRAINING
APPLICATION
Name:________________________________________________________Date:_________________________
Address:______________________________________________________________________________________
Emailaddress:__________________________________________Phone:___________________________
Profession___________________________________________________________
Howdidyoulearnaboutthetraining?____________________________________________________
TypeofPayment:____$695fullpayment____$249monthlyinstallments(Youwillreceiveaninvoiceviaemailonceapproved)
Pleasesendanemailtoinfo@mindbasedhealing.organdincludethefollowing:
• List of training in hypnosis / hypnotherapy, neurolinguistic programming(NLP),coaching,psychotherapy,andanyothertrainingyoufeelispertinent
• Copyofcertificationsinhypnosis/hypnotherapyandNLP(Pdforphotographofthecertificateisacceptable).
• Describeyourexperience(years,numberandtypeofclients,etc)youhaveinutilizing your training in NLP and hypnotherapy. This is only additionalinformation to help the trainer understand the level of experience of thepractitionerstobettersupportyourlearningandpracticebuilding.
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