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