Application Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Title *MrMrsMissMsOther (please specify below)If you checked 'Other' please specify below....Name *FirstLastAddress (including postcode) *Mobile Phone Number *Home Phone NumberEmail *Date of Birth *Nationality *Marital Status *SingleMarriedLiving with partnerDivorced/separatedCurrent OccupationBrief Occupation HistoryYour HobbiesWhat other subjects have you studied as an adult (whether or not you obtained any qualifications)?Have you had, or do you have, any serious illnesses (including psychiatric/emotional)? If ‘Yes’, please give brief details here:Have you any previous training in hypnosis, hypnotherapy or psychotherapy? If ‘yes’ please give brief details:Please give details of why you wish to study hypnotherapyHow did you hear about the Royal Berkshire College of Clinical Hypnosis?REFERENCES: Our accrediting bodies require us to ensure your suitability to train and work as a hypnotherapist. Please provide contact details of two people who we may contact for a personal reference. These should not be a close relative or partner.REFERENCES contd....PAYMENT: Current fees £2950 if paid in 10 monthly instalments of £295, or £2750 if paid in full 2 weeks before the first weekend of the course. Deposit of £295 is to be paid when you submit your application in order to reserve your place. This will be deducted from your final balance. Balance: (Payable two weeks before the first weekend of course) Balance of discounted upfront payment £2750-£295=£2455£295 By instalments per monthly module (Your deposit will be used for the last weekend)Please enclose payment with this application of £295 by making a bank transfer to Bank: HSBC Acct Name: RBCCH Sort Code: 40-47-09 Acct no: 01782711 IBAN: GB27HBUK40470901782711 BIC: HBUKGB4113FAdditional Comments or questions. If you have any questions or queries about completing this form or about the course itself, please contact Kevin by telephone: 01189 888839 or via email: ks@RBCCH.com.Submit