Certificate of Clinical Hypnosis Enrolment Form

First Name*
Middle Name
Surname*
Preferred Name*
Gender*
Date of Birth*
DD slash MM slash YYYY
Mobile*
Email*
Enter Email Confirm Email
Address Line 1*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Postal Address (if different from above)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date of Sessions*
Enrolment Acknowledgements and Declarations:
Please confirm you agree to following before proceeding with your enrolment. You will be asked to sign the full terms and conditions once your enrolment is processed:
- I acknowledge that all course content is the Intellectual Property of the Institute of Applied Psychology, and that the distribution of IAP resources in any way, shape or form, physically or electronically, is expressly forbidden without the written permission from IAP
- I understand that studying with IAP will require me to have a working knowledge of online and offline learning and communication systems and platforms such as email, student learning portals, online videos, word processing etc.
- I understand that the Mode of Delivery for any IAP course may be changed, amended, adjusted or reviewed and that any such change does not constitute a cancellation of the course
- I understand that any and all deposits that I may pay to IAP are non-refundable
- I have read and understood the Terms and Conditions for enrolment (found at Click here and understand that by proceeding with this enrolment I am in agreement with the Terms and Conditions.
- I understand that accessing the course content constitutes the commencement of the course and that once I have accessed the course I will no longer be eligible for a refund of any and all fees.
Please check the box above if you agree to Enrolment Acknowledgements and Declarations
Payment*
Certificate of Clinical Hypnosis Course Price*
Price:
Certificate of Clinical Hypnosis Course 20% Deposit*
Price:
Certificate of Clinical Hypnosis Course 50% Deposit*
Price:
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Amount of Deposit
Course Amount % to pay
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Coupon
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This Sets The Type of course

The type of the activity. w = workshop, p = accredited program, el = e-learning
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Click to open the terms and Conditions of Enrolment