Omni Hypnosis Training Center® of  Washington, DC

Basic Through Advanced Hypnotism Enrollment Form

Date: ________________________

Name: ________________________________________ Home Address: __________________________________ 

City: ________________________ State:_______ Zip:_______________ Home Phone: (          )_______________

Work Phone: (         ) _______________ Email Address: ______________________________________________

Occupation: ___________________________________ College Degrees: ___________________________________

Previous hypnotism training?   Yes   No   Where: _____________________________________________

How did you hear about Omni? ____________________   Are you currently an active NBHEC member?   Yes   No  


Basic – Advanced  Hypnotism Training Starting Date: ____________________________________________________

Should Omni cancel a training for any reason, all monies placed on deposit will be promptly returned via the same method payment was made. Omni cannot be responsible for any other fees incurred by students pertaining to a scheduled training.  A $300 non-refundable processing fee will be charged for participant cancellation within seven (7) days of class starting date.  Balances are due to be paid in full on or before class starting date by credit card, cash, money order, bank certified or cashier check.  No personal/business checks accepted on final balance unless (United States students only) RECEIVED two weeks in advance of training starting date.  Training fee does not include hotel accommodations or meals.

Please Print Your Name (Exactly as you want it on your certificates)





Signature                                                                                                                              Date

Please fill out this form,

Email to:

Fax it to:  (240) 334-4886

If you have any questions, please call (202) 570-4757



© 2019 by Omni Hypnosis Training Center®. All rights reserved.

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