Foundations in Conscious Heart Hypnotherapy Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

For more information, contact us at (662) 841-8020 or info.chht@gmail.com

Email *

First and Last Name *

Address (street, city, state, zip) *

Telephone: *

Area of Specialization: *

Graduate and/or Post Graduate Degrees:

Licensure/Certifications or Relevant Trainings: *

Please share with us why you are choosing CHHT training and how you feel this process may be useful in your practice: *

How did you learn about Conscious Heart Hypnotherapy? If you were referred by someone, please share their name and contact information with us so we can thank them for bringing us together. *

For which date are you registering? *

Fall 2023 (Module 1: August 24-26, 2023, Zoom; Module 2: September 28-30, Zoom; Module 3: October 23-27, South Dakota))

Required

Please Select a Payment Option: *

Investment: $3851 ~ Deposit: $350 Due Now (Balance due 7 days prior to Module 1 start date)

Venmo: @CHTLLC-2008

Zelle: melissa@chtllc.com

Check payable to CHHT: Mail to: CHT, ATN: CHHT Registration, 302 S. Spring St., Tupelo, MS 38804

Credit/Debit Card via Phone (4.5% fee): Call 662-841-8020

Select all discount(s) that apply for you:

Yes, I attended the Q&A ($100 discount)

Yes, my deposit OR full tuition is being paid by December 24, 2022 ($100 discount)

Yes, I am attending with a friend/friends ($50 discount per friend who registers, lists you as their attending friend, and attends with you)

Name(s) of friend(s) attending with you:

Statement of Commitment *

I commit to attending all required days of the training in their entirety.

I commit to respecting my fellow students and maintaining confidentiality.

I commit to paying my full tuition balance within 7 days prior to Module 1 start date.

I commit to NOT teaching this course without expressed permission and training.

I commit to sharing course materials (scripts) ONLY with others who have received this training.

I commit to showing up with an open mind and an open heart for learning and growing.

I commit to communicating with one of the teachers immediately if any unforeseen circumstance arises that would cause me to be out of integrity with any of the above stated commitments.

Required

Are there any physical limitations that would require accommodations during our in-person meeting?

Signature *

By typing your name below, you are providing a statement of agreement to adhere to the terms outlined in this document.

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms