Classs Enrollment Form

Full Name*

First NameLast Name

Preferred Name for Certificate

Phone Number*

Area CodePhone Number

Mobile Number*

E-mail*

Select your Class or Event:
(PR) = Pre Requisite*

Confidential Personal Information

ThetaHealing™ is a supplement to medical care, not a substitute for it. Please indicate any conditions that your tutor should be aware of, or that may interfere with your ability to participate in this class: i.e. physical or psychological issues, pregnancy, injuries, allergies, the need for medications etc… or any special dietary requirements:

Please list special requirements if any:

Please provide the name and (preferably mobile) number of a person to contact in case of an emergency:*

I give permission for my contact details (email and/or phone no) to be shared with my classmates at the end of class *

YesNo

I have completed pre-requisite classes (if any), with a Certified ThetaHealing™ Teacher *

YesNo

Which method of payment will you be using?*

Credit CardOnline Transfer

Request a receipt

Please send me a receipt

Please choose which applies to you.*

I am paying in full by Credit Card - I will call Nancy Cate with my detailsOnline Transfer - I am depositing the full amountOnline Transfer - Deposit & the remainder no later than 2 weeks prior to class

Do you agree to the Terms & Conditions?*

Yes, I have read and I agree.

Click HERE for our Terms & Conditions

Notes:

Knowledge Tree Classes<br /> Enrolment Form