Workshop Registration Form

Step 1 of 2

50%

Name*
First Last
Student Photo
Please upload a passport style profile photo. We do need this to process your registration. You can also mail us a photo or email us a "selfie" or photo from your phone.
Workshop Date*
Date Format: DD slash MM slash YYYY
Workshop Name*
Contact Details
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Mobile Phone*
In international format - for uk the international code is +44
Email*
Enter Email Confirm Email
Date of Birth
Date Format: DD slash MM slash YYYY
Workshop Suitability Questions
Have you ever been diagnosed, or had any reason to believe you were suffering from a psychiatric condition?*
- Yes
- No
Please provide additional information if you answered YES
Do you consider your spoken English fluent enough to train in hypnotherapy?*
- Yes
- No
Please provide additional information if you answered "I'm not sure" or "No"
So that we can ensure your comfort and safety while attending training, please let us know if you have any special needs with regard to disability?
None
Educational background / Reasons for taking the course
Please list below your educational qualifications, university degrees, post-graduate level or other therapy or psychology related qualifications:
Why do you want to take the workshop?*
Please let us know what you'd like to get from this workshop.
What is your current occupation?*
Where did you hear about The UK College of Hypnosis and Hypnotherapy*
Are you interested in taking the Diploma in Cognitive Behavioural Hypnotherapy*
- Yes
- Maybe
- No thank you
Confirmation and Agreement
Confirm correct information*
- I confirm all the information above is correct.
Please sign here*
This is your digital signature for this form.

Written by Mark R. Davis on Wednesday 9th January, 2019

Step 1 of 2

Contact Details

Workshop Suitability Questions

Educational background / Reasons for taking the course

Confirmation and Agreement