"What we think, we become" – Buddha

Enrollment Agreement

The fields marked with * must be filled.
* First Name:		* Last Name:
* Address:
Address 2 Line:
* City:		* State:
* Country:		* Postal/Zip code:
* Home Phone:	( )	Business Phone: ( )
Fax:	( )
* E-mail:
Referred by:	First name:	Last:
Phone:	( )
E-mail:

Trainings

	The Journey into Empowerment
	NLP Practitioner
	NLP Master Practitioner
	Other

* Date:			(ex.: dd/mm/yy - 05/09/10)
* Location:
Total:
Notes:

Payment Options

	Option #1: Payment is full, 10% off. I enclose $
	Option #2: Payment is full, 5% off. I enclose $ down, and the balance to be paid in full 30 days prior to first day of training.
	Option #3: I enclose $ down plus # of payments of $ per month

Method of Payment

	Cash
	Money order
	Check #
	Credit Card #		3-Digit:		Exp. Date:		(ex.: mm/yy - 09/10)