REGISTRATION FORM

The Newton Institute Life Between Lives Hypnotherapy Training

May 3-7, 2010 (Orientation May 2)

Location
Topsail Island, (near both Wilmington & Jacksonville), NC, USA

PLEASE FILL OUT COMPLETELY

Name:
Address:
City, State or Province:
Zip/Postal Code:
Phone Number (home):
Phone Number (work):
Phone Number (fax)
(optional):
Email Address:
Website Address (if you
have one):
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________

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 Life Between Lives Hypnotherapy to the training for reference.
2) Students are required to bring a digital recorder (and if possible 2 lapel mics (1 for client
and 1 for student – available at Radio Shack) for recording their LBL sessions at training.

Education and Background:

Hours of Previous Hypnosis Training:

(Provide documentation of school or training institution/hours by mail, along with a one page
biography of your hypnosis and past life regression experience.)

100-150 151-200 200+

TNI Life Between Lives Hypnotherapy Training – May 3-7, 2010 Registration - page 1
Organization that Conferred Hypnosis Certification or Training
(Provide supporting documentation by mail/digitally.)

Type of Certification: ____________________________________________

Type of Training: _______________________________________________

Years in Hypnotherapy Practice: (2 years minimum*)

1-2 2-3 3-4 4-5 5-10 10+

Approximate Number of Past-Life Regression sessions facilitated:

1-10 11-20 21-30 31-40 41-50 51+

How many years have you been facilitating PLRs? _______________________

How many PLRs do you average per month? _____________________________

Are you experienced in In Utero or Pre-natal regression? ___________________

__________________________________________________________________

How many PLRs have you personally received/ experienced? ________________

On the space for information below, or typed/printed and attached, please detail any additional
training, education, and/or experience relevant to LBL Spiritual Integration (aka 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.

TNI Life Between Lives Hypnotherapy Training – May 3-7, 2010 Registration - page 2
Payment Information:

Do not send your course fee with this application. Upon acceptance into our course you will
receive payment instructions.

Refund/Cancellation Policy: A 90% refund of the Course fee and beach house accommodations
is offered for cancellations received by February 15, 2010 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.

Lodging and Accommodations: The Life Between Lives Hypnotherapy Training will
take place at “License to Chill”, 1925B Southshore Drive, Topsail Island, North Carolina, USA.

Reservation Procedures: You are responsible for your own reservations.

Staying Onsite: Student accommodations are available onsite in a shared room for an additional
$65/nt. (oceanfront beach house with full kitchen; breakfast and dinner are on your own). Please
request this when sending in your registration.

After you have been accepted into the course if you have not made arrangements to stay onsite,
lodging is also available at the Holiday Inn Express, North Topsail Island at
www.hiexpress.com. The Holiday Inn Express Hotel & Suites located one mile off the beautiful
island of Topsail in the community of Sneads Ferry. It is about 20 minutes north of the training.
It is a premier hotel offering spacious rooms with scenic views of North Shore Country Club.
HOLIDAY INN EXPRESS HOTEL & SUITES, 1565 Highway 210, Sneads Ferry, NC
28460 USA. We are in negotiations with the Holiday Inn for a group rate. For now it is
$125.99/nt.

Individual Reservations by Telephone 1-910-327-8282 (Hotel front desk). Be sure to tell

reservations you are attending the Newton Institute training to receive our special group rate.

I would like to stay onsite at “License to Chill”

‰ Yes
‰ No

I will make my own reservations at the Holiday Inn upon acceptance into the training.

‰ Yes
‰ No

Would you like us to assign a roommate?

‰ Yes
‰ No

TNI Life Between Lives Hypnotherapy Training – May 3-7, 2010 Registration - page 3
**By submitting registration documents for this course, you agree to have read and to accept the
terms of TNI’s Code of Ethics for LBL Practitioners.

Submit all questions regarding registration and accompanying documentation to:

Registrar:
Jimmy Quast
2 Papermill St
Easton, MD 21601
USA
1-410-819-8835
Email: jquast@goeaston.net

TNI Life Between Lives Hypnotherapy Training – May 3-7, 2010 Registration - page 4