Workshop Registration Form - The UK College of Hypnosis and Hypnotherapy

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*

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

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?

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.

Step 1 of 2

Contact Details

Workshop Suitability Questions

Educational background / Reasons for taking the course

Confirmation and Agreement