Pre Registration form

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Pre-Registration Form

Class you are registering for:
Basic/Self Hypnosis Advanced Hypnosis Hypnoanalysis

Forensic Hypnosis
(Prerequisite: Basic Hypnosis Course or equivalent experience and understanding.)

General Information:

Last Name First Name

Birth date ADDRESS Suite/ APT#
CITY STATE
ZIP CODE

Country:
if not United States of America, please indicate what country you'll be attending from.

Social Security#

Home Phone: Work Phone:

Best time to call:

FAX

Email Address:

APPLICATION, TUITION AND PAYMENT SCHEDULE APPLICATION, TUITION AND PAYMENT SCHEDULE in U.S. Funds Only, Drawn on a US Bank
Required APPLICATION FEE - $25.00 / ($10.00 to be returned if application is denied by the school. *TAP programs do not cover fees or books)

I have read and understand

Tuition Deposit Fee Information (to finalize my place in the classroom) $140.00 is required at least 10 days prior to the first day of class. I have received and read the school catalog. I understand the payment and refund policies listed in the catalog of entry, having been pre accepted as a student

I choose the following tuition plan. (Does not include Materials Fees) Plan 1 For full tuition payment (plus the application fee) on or before 14 days prior to the 1st day of class, with Cash or Check only receive a $25.00 discount

Plan 2 For payment of $140.00 deposit, (plus the application fee), the balance due the first day of class.

Plan 3 For payment of $140.00 deposit, (plus the application fee) with half of the balance due the 1st day of class, and the total balance due the 1st day of the second weekend of class.

I agree to pay Infinity Institute International, Inc., the sum of $ according to Plan above. First payment due 10 days before, the start of first class date.

Please read and sign – Contract Agreement
CONTRACT AGREEMENT: I hereby certify that all information contained in this application is true and complete. I agree that Infinity Institute may record classes in video and/or audio formats for later distribution and I grant my permission to be a part of any such recording. I understand that no certification or diploma will be issued until all financial obligations are met. This signature also serves as Credit Card authorization for later agreed upon transactions. Submission of this electronic form, constitutes a legal binding contract.

SIGNED	DATE:
COURSE TITLE	COURSE DATE:

Infinity Institute International, Inc is licensed by the State of Michigan Dept. of Licensing & Regulatory Affairs to teach Hypnosis as an occupation, #19840003.
© 2012 Infinity Institute International, Inc. All rights reserved |1302 N. Altadena Ave. Dept. 100 Royal Oak, MI 48067-3666 USA | 248-850-3591