Payment is included at the following rate (tick box):

[  ] Standard Rate: £99
Payment must be received within two days of the course date.

[  ] Repeat Booking/Unwaged Rate: £79 (20% Discount)
Special discount rate for unwaged, or those wishing to re-attend the course.

Contact Details

Name: _____________________________________________________

Address: ___________________________________________________

__________________________________________________________

__________________________________________________________

_______________________________ Postcode: __________________

Phone: _____________________ Email: _________________________

Payment Details

[  ] I enclose a cheque/postal order (amount ticked above) made payable to "HypnoSynthesis" OR
[  ] I wish to pay by credit/debit card and authorise you to debit my account with the amount of £__________

My card number is: __________________________________________

Expiry date of card: ___ / ___ Valid from date (Switch): ___ / ___ Issue Number (if present): ___

Card security code: ______ (The last 3 digits located on the reverse of the card.)

Signature: _________________________________

Cancellations Policy: At least two weeks prior notice is required for any cancellation.
HypnoSynthesis® is a trading name of Donald Robertson Training Ltd., Registered in England as Company No. 05499462