Note: an interview with Instructor Mary Elizabeth Raines is required before acceptance into the past-life regression counselor 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.

Academy for Professional Hypnosis Training
PAST-LIFE REGRESSION COUNSELOR TRAINING
REGISTRATION FORM

 

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 class communications)

_________________________________________________________________

 

DATE OF BIRTH ________________________________________

 

CURRENT PROFESSION_______________________________________________________________________

 

EDUCATION OR OTHER TRAINING YOU HAVE HAD WHICH MIGHT BE PERTINENT TO PAST-LIFE COURSE:

 

_________________________________________________________________________________________

 

BRIEFLY DESCRIBE YOUR INTEREST IN STUDYING TO BECOME A PAST-LIFE REGRESSION COUNSELOR:

 

 

 

_________________________________________________________________________________________

 

    PLEASE CHECK ALL THAT APPLY
     

    I would like to be connected with another student(s) for sharing a room
     
    I am interested in a double
     
    I would be interested in being on a list to carpool to/from airport

    I would be interested in being on a list to carpool to/from class

 

PLEASE SHARE ANY PERSONAL CONDITIONS INCLUDING MEDICAL HISTORY/SERIOUS ALLERGIES/CIRCUMSTANCES OF WHICH YOU WOULD LIKE US TO BE AWARE:

 

_________________________________________________________________________________________

ELIGIBILITY REQUIREMENTS: To be eligible for certification, students are asked to attend all sessions without excessive tardiness or early departure, to participate in all exercises, and to demonstrate by the end of the course an ability to conduct a past-life regression session. Class begins at 9:00 a.m. on Tuesday, May 18, 2010. Class ends at 6:00 p.m. on Saturday, May 22, 2010. 

I have read, understand and agree to all terms and conditions (click to go to terms and conditions page):



Signed_______________________________________________________Date_______________________

PERSONAL RESPONSIBILITY CLAUSE: Each individual is responsible for her/his own emotional, physical and mental wellbeing. By signing this contract:
1. You agree to take personal responsibility for yourself.
2. You agree that you have never been hospitalized for psychiatric reasons or for any mental illness.
3. You agree that you, your family and your heirs will hold the Academy for Professional Hypnosis Training, Laughing Cherub Hypnosis and/or Mary Elizabeth Raines harmless and not liable for any perceived or actual emotional, physical or mental injury or loss.

 

    DEPOSIT ENCLOSED IN THE AMOUNT OF: _______________($335.00 US dollars minimum)

  • General Tuition: $675.00 (U.S. dollars)

  • Earlybird Discount: $625.00 (U.S. dollars) for whose who have completed interview & sent registration by March 6, 2010.

  • Bring-a-Friend Discount: $35 apiece.

    • Registration and deposit must be postmarked by the above date to qualify for earlybird discount. Out of courtesy to early enrollees, there can be no exceptions to the above dates. See below for discount and refund policy.

    Call us if you have extra deductions for bringing along a friend or must pay by PayPal: (920) 867-3900

     

 

Please make out check to "Laughing Cherub" and mail together with this form to:

        Laughing Cherub Unlimited
        Att'n: M. E. Raines
        E5664 Waukaunaka St.
        Weyauwega, WI 54983

Thank you, friend! We look forward to meeting you soon!

     

Note to students: Your registration is your commitment to take the class. Our commitment to you is that we will hold the class as scheduled, barring circumstances called "acts of God." The below refund policy is in place since our commitment entails making a substantial, nonrefundable deposit for multiple items as supplies, catering, office work, airfare, classroom space rental & lodging.

DISCOUNT AND REFUND POLICY

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 course. In the event of any delay in payment, all discounts will be null and void.

Refund policies: a minimum deposit of $335 is required to enroll. The deposit amount, minus a $35 bookkeeping fee, is completely refundable up until four weeks before the beginning of class. From four weeks to one week before the start of class, refunds will be given for any amount in excess of $185; the remainder is non-refundable, however $150 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; no exceptions). Starting one week before the opening of class and continuing after class begins, there will be no refunds.

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