Jane A. Hildenbrand, M.S., MHt
Certified Transpersonal Hypnotherapist and Trainer for the
National Association of Transpersonal Hypnotherapists (NATH)
5429 Guilford Avenue
Indianapolis, IN 46220
317-254-8732 – Office
317-331-7833 – Cell
Email -
Transpersonal Hypnotherapist/Entry Level Registration
(print or type)
(Name______
(as you want it to appear on your certification)
Address______
City______Zip Code______
Home Phone (______)______Cell Phone (____)______
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Emergency Contact (______)______
Education
College/ Other Higher Education or Training
Name City/State Dates Major Degree Received (yes/no)
______
High School:______
(Recommended – If N/A. then a G.E.D. is required for certification)
Hypnotherapy Training/Experience______
______
(Please attach certifications from other institutes if applicable)
Class: Entry Level Hypnotherapy Certification/Transpersonal Hypnotherapy (limited to 10 students)
Wednesdays, September 6 through November 8, 6:00p – 10:00p
5429 Guilford Avenue, Indianapolis, IN 46220
Fee: $995.00 for 10 week class. $350.00 non-refundable deposit preregistration fee/entire course fee may be paid with registration. Final fees must be paid the first night of class. The non-refundable deposit may be utilized toward other professional services or classes provided by Jane within one year if unable to attend. Checks, credit cards, and PayPal are accepted. Checks should be made out to Jane Hildenbrand. PayPal payments to be made through . Contact Jane for credit card payments.
Required Goal Statement: A one-half page goal statement must accompany the pre-registration fee. Include why you are taking this course and your goals for the future in relation to hypnotherapy. Please use the last page of this registration to type or write your Goals Statement.
Required Textbooks: Clinical Hypnotherapy: A Transpersonal Approach, Revised Second Editionby Allen Chips and Script Magic: A Hypnotherapists Desk Reference, Revised Second Edition byAllen Chips. Textbooks may be purchased through NATH by contacting Dee Chips (Cofounder of NATH) at 800-296-6463 or 252-480-0530. Please begin reading/reviewing the textbooks prior to class start.
Students are also required to complete a 3-5 page book review written by a hypnotherapist. Contact Jane Hildenbrand for book suggestions and/or approval. This review will be due Session 8 of course.
Core information on course may be found at and click on entry level certification. Please note there may be minor adaptions tocourse due to local course timeline and student needs. The ten week course outline and weekly topics will be distributed the first night of class.
Exam: There will be an open book exam that must be turned in by or before Week 10. This exam is based on the Clinical Hypnotherapy text by Allen Chips. This exam will be emailed and may also be found for downloading on the NATH website.
All assignments must be completed by or prior to November 8 in order to complete class.
Students will receive an attractive certification from NATH, as well as a one year membership to NATH.
I hereby subscribe that all the information contained in this registration is true and complete.
Signature Date
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Faculty Signature Date
Goals Statement