:: THE HYPNOTHERAPY SCHOOL OF INDIA

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* Fields are mandatory

First Name * :

Last Name * :

Date Of Birth * :

Day	Month	Year

E-mail * :

Address * :

City :

State :

Pin Code :

Phone No(s). * :

Please Register me for the *
following workshop :

I would like to make a payment by * :

Cash	Cheque
Demand Draft	Credit Card

Cash Payments can be dropped off at address given below.

Cheque/Demand Drafts need to be made out to The Hypnotherapy School of India and may be
mailed or dropped off at :

The Hypnotherapy School of India

81, Defence Colony Flyover Market,

New Delhi - 110024

Phone : 011-24617278, Fax: 011-24636063, Email: hypnotherapyschool@rediffmail.com

Please note: Registrations will only be complete once payment has been received.

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