EUROPEAN COLLEGE OF HYPNOTHERAPY
www.european-college.co.uk
Tel: 01784 479930
PRINTABLE BOOKING FORM
PLEASE TICK :
I should like to enrol on the following course:
• GENERAL Diploma Course in Hypnotherapy
Starting : (enter date)………………………………...
• GENERAL Diploma Course in Past Life Therapy &
Spirit Releasing Therapy
Starting : (enter date)………………………………...
• INTENSIVE Diploma Course in Hypnotherapy
Starting : (enter date)………………………………...
• INTENSIVE Diploma Course in Past Life Therapy &
Spirit Releasing Therapy
Starting : (enter date)…………………………………
CONFIDENTIAL INFORMATION:
Name_________________________________________________________________
Address_______________________________________________________________
_____________________________________________________________________
____________________________________________Post Code_________________
Email address__________________________________________________________
Telephone(s)__________________________________________________________
Occupation____________________________________________________________
Qualifications__________________________________________________________
I enclose a deposit cheque of ____________ (half the total course fee)
and agree to pay the balance at the start of the course.
(If you require a special payment plan, due to hardship, please telephone us.)
Please state where you heard about us ________________________________________
CONFIDENTIAL DECLARATION
Have you ever been convicted of a criminal offence?
YES/ NO If Yes, please give details __________________________________________
______________________________________________________________________
Please state any serious physical or psychological illness that
you have experienced _____________________________________________________
______________________________________________________________________
Do you currently have any physical or psychological disorder(s)?
If so, give details_________________________________________________________
______________________________________________________________________
Are you taking any medications? If so, please give details.
______________________________________________________________________
Have you ever been the subject of professional disciplinary
proceedings ? YES / NO If so, please give details_________________________________
______________________________________________________________________
Should any of these situations arise during my training with you, I will inform you immediately.
Signed ______________________________________________ Date______________
Send the completed Booking Form with your deposit (half the total course fee, made out to
The European College of Hypnotherapy) to:
The European College of Hypnotherapy, 5 Schroder Ct, Northcroft Rd, Egham, Surrey TW20 0EH (A receipt will be sent)