APPLICATION FOR ENROLLMENT
Name:
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Please, explain your interest in Medical Hypnosis:
Please, list any books you have read on Medical Hypnosis:
Please, Explain how you plan to integrate this class in your practice:
Have you been hypnotized before?:
I understand that this course of instruction is a class participation activity. I understand that upon successful completion I will be certified by the World Institute of Cognitive Sciences, the Self-Empowerment Education Center, and the International Council for Medical and Clinical Therapists.
Please, make check or money order payable to: Self-Empowerment Education Center For Credit Card Payment Please Enter All Necessary Information Below: 1-888-658-2014 for registration only Please Check Appropriate Box:
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