application & registration form - the newton...
TRANSCRIPT
The Newton Institute Life Between Lives® Hypnotherapy Training
APPLICATION & REGISTRATION FORM
PLEASE FILL OUT COMPLETELY
Date of LBL Training (for which you are applying):
Month_________________________________ Year____________________
Location of Training:________________________________________________
Personal Information
Name:___________________________________________________________
Address:_________________________________________________________
City, State or Province:______________________________________________
Zip/Postal Code/Country:____________________________________________
Phone Number (mobile):_____________________________________________
Phone Number (other):______________________________________________
Email Address:____________________________________________________
Website Address (if you have one):____________________________________
Education and Background
Years in Professional Hypnotherapy Practice:____________________________
Full time or Part time? If part time, please be specific:______________________
________________________________________________________________
________________________________________________________________
Total Hours of Previous Hypnosis Training_______________________________
(Breakdown Hours below)
**PLEASE DO NOT INCLUDE HERE ANY TRAINING OTHER THAN YOUR HYPNOSIS OR HYPNOSIS-BASED PAST LIFE REGRESSION TRAININGS.**
TRAINING/CERTIFICATION 1
Title of Training/Certification:
________________________________________________________________
Date:___________________________________Total Education Hours_______
Organization that provided this Training:
________________________________________________________________
Type of Certification/Training (ie: Past Life Regression, etc.)
________________________________________________________________
Was all or some of this training online? YES NO
If yes, please elaborate:_____________________________________________
________________________________________________________________
Name & Phone Number of Organization Contact Point:
________________________________________________________________
________________________________________________________________
TRAINING/CERTIFICATION 2
Title of Training/Certification:
________________________________________________________________
Date:___________________________________Total Education Hours_______
Organization that provided this Training:
________________________________________________________________
Type of Certification/Training (ie: Past Life Regression, etc.)
________________________________________________________________
Was all or some of this training online? YES NO
If yes, please elaborate:_____________________________________________
________________________________________________________________
Name & Phone Number of Organization Contact Point:
________________________________________________________________
________________________________________________________________
TRAINING/CERTIFICATION 3
Title of Training/Certification:
________________________________________________________________
Date:___________________________________Total Education Hours_______
Organization that provided this Training:
________________________________________________________________
Type of Certification/Training (ie: Past Life Regression, etc.)
________________________________________________________________
Was all or some of this training online? YES NO
If yes, please elaborate:_____________________________________________
________________________________________________________________
Name & Phone Number of Organization Contact Point:
________________________________________________________________
________________________________________________________________
IF YOU NEED LIST ADDITIONAL TRAININGS PLEASE USE SPACE BELOW:
How many years have you been facilitating Hypnosis-based PLRs?__________
Approximate Number of Past-Life Regression sessions facilitated:___________
How many PLRs do you average per month? ___________________________
Are you experienced in In-Utero or Pre-natal regression? YES NO
Details: _________________________________________________________
How many PLRs have you personally received/ experienced? ______________
How many LBLs (if any) have you personally received/ experienced? _________
If applicable, on the space for information below please detail any additional training, education, and/or experience relevant to LBL/Spiritual Integration/Spiritual Regression. On a case-by-case basis, documented proof of additional coursework, workshop attendance, or experiences as a hypnotherapy practitioner may substitute for the above entry requirements.
As an applicant to The Newton Institute LBL Training program, we are interested in learning more about you and how you would align with the philosophy of our organization. Please thoughtfully answer each of the following questions, and feel free to add in any other information you think may be relevant.
1. What was it that drew you into the field of hypnosis in the first place? Was there, for example, an ‘aha moment’ when you realized you wanted to become a hypnosis practitioner, or did your motivation evolve over a longer period of time?
2. How has the field of hypnosis influenced who you are as a person and your future goals?
3. Would you describe yourself as analytic or intuitive in your therapeutic approach to hypnosis clients, and why?
4. Please give examples of how your hypnosis training included the following required techniques:
Extensive grounding in trance induction work, deepening and recognizing different states of hypnosis, robust age regression techniques and the ability to refame/release traumatic events.
5. Our proven LBL methodology along with the organization has taken us years to develop and refine. If you are going to operate under the banner of ‘The Newton Institute’, you will be expected practice what you have been taught and function under our guidelines when facilitating ‘Life Between Lives’ hypnosis sessions. Do you have any discomfort with these expectations?
Please include/attach documentation of school or training institution/hours by email or mail (for example: scan and email your certificates), along with a biography (no more than one additional page) of your hypnosis and past life regression experience.
Required reading:
Journey of Souls, Destiny of Souls and Life Between Lives Hypnotherapy, all by Dr. Michael Newton.
What to bring to the training:
1) Students are to bring he book, Life Between Lives Hypnotherapy to the training for reference.
2) Students are required to bring a digital recorder for recording their LBL sessions at training.
Payment and Lodging Information:
By signing the application you are stating acknowledgement and understanding of each of the following statements:
1. The cost for this course is outlined in the training details on the website.
2. Do not send your course fee with this application. Upon acceptance into our course you will receive payment instructions to complete your payment through PayPal.
3. Refund/Cancellation Policy: A 90% refund of the Course fee (not including room and meals) is offered for cancellations received before 90 days prior to the training, and on a sliding time scale thereafter. A portion of retained payments may be applied to a future training within two years of registration date.
4. Lodging and Accommodations vary with each training. This information is outlined in the training details on the website.
Please place your initials in the spaces below to indicate each is a true statement:
______I have read and agree to the terms of TNI’s Code of Ethics for LBL Practitioners.
______I have included my required documentation with this application form
**Please note that your application will not be considered if incomplete
______ All of the information supplied in this application is true and complete to the best of my knowledge.
Name (Printed)__________________________________________________
Signature______________________________________________________
Date_____________________________
Submit application and accompanying documentation (electronic preferred, or paper) to:
Registrar:
Judith Huffman Email: [email protected]
1121 Military Cutoff Road Suite C312 Wilmington, NC 28405 USA
For questions related to this training program, or, if you require further information, please email Judith Huffman at: [email protected]