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Training course registration form
Event Address: West Midlands Hypnotherapy Centre. 3 Middleton Hall Road, Birmingham. B30 1AB
Contact us at +44 (0)121 251 6172 or
admin@balancedapproach.co.uk
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Email
*
Your email
What course(s) will you be attending?
*
Hypnotherapy diploma (6-days)
Clinical hypnotherapy practitioner (16-days)
NLP Practitioner (7-days)
Coaching module (3-days)
Complete coach (7-day NLP + 3-day coach modules)
NLP Master Practitioner (8-days)
Other:
Required
Course start date (1st course if more than one)
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/
DD
/
YYYY
Name
*
Your answer
Email
*
Your answer
Current role/job
Your answer
Organisation
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Address
*
Your answer
Telephone number
*
Your answer
Are you in good physical health?
*
Yes
No
Required
Do you suffer from or have ever suffered from the following?
If yes, please check the box.
Asthma or bronchitis?
Clinical depression?
Epilepsy?
Heart Condition?
Are you taking any medication?
If yes to any of the above, please give details
Your answer
Do you suffer from any physical disability or psychological condition that could prevent full participation in an active study programme?
If yes, please give details.
Your answer
I understand that I am committing to pay before attendance.
*
Yes
payment plan agreed
Required
BACS Payment details and business address
BACS Payments
: For BACS payment and invoicing etc. Please email us
admin@balancedapproach.co.uk
Balanced Approach. 3 Middleton Hall Road, Kings Norton, Birmingham. B30 1AB.
A copy of your responses will be emailed to the address you provided.
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