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To participate in the 2011/2012 Holistic Health Counseling Practitioner Training Program, please fill out the following form.

After doing so, our admissions advisor will get back to you to provide you with further enrollment instructions.

Enrollment Form
First Name (*)
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Last Name (*)
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E-mail (*)
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Day Phone
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Evening Phone
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Street
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City
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State
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Zip
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Country
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Please briefly describe your present skills and professional background:
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How did you hear about the program?
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Choose the program you are interested in:
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For online participants:

Choose the weekends you plan to attend live in NY.
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Payment Options

Filling out the following section requires that you talk to our Admissions Advisor first. Please call (646) 812-0091 to discuss the discounts and payment options.

1. I am making a $600 deposit and will be making monthly payments. Please enter the number of months of your payment plan.
Payment plan:
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2. I am paying for the course in full and receiving a discount. Please call the Admissions Advisor at (646) 812-0091 to receive your discount and enter the amount here.
Discount amount:
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3. I will pay by check. Check if this applies.
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4. I will pay by credit card. (For security, please call to pay over the phone.)
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What discounts apply to you? (Call us to discuss the applicable discounts )
Applicable discounts:
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What is the total fee due?
Total due:
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Terms and Conditions

Terms
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