<the academy of healing nutrition: enrollment>

Enrollment form

Name
Address
City
State
Country
Zip/Post code
Telephone
Cell phone
Fax
Email
Location (please check one of the following)
New York London Sydney
PAYMENT DETAILS
New York tuition for our program is US $7500. Australian Tuition for our program is A $7500 includes GST. London tuition for our program is E7500 (in euros). A $600 deposit is required.
Tuition and Discounts:
SAVE $750 for full payment one month before course starts SAVE $500 for full payment two weeks before course starts $1000 EACH for immediate family member discount SAVE $500 if you are 24 or under SAVE $300 for traveling over 100 miles, one way SAVE $400 for traveling over 300 miles, one way SAVE $600 for traveling over 500 miles, one way
Method of payment:
I will be paying with a credit card I will be posting a check (we will email you details where to send)
If paying by credit card:
Visa MasterCard
Name on card
Card number
Exp. date
Payment amount
Your transaction is secure. We will email you soon with more details on payment and venue.
ABOUT YOU
Please briefly describe your present skills and professional background:

How did you hear about the program?

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