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Collective Intelligence Enrollment Form

Teresa Epstein - NLPU Coordinator
Phone: (831) 336-3457
Email: teresanlp@aol.com

Enroll Online for This Unique Opportunity

We guarantee that if for any reason you need to change your plans, we will fully refund your money minus a $250 cancellation fee.

Enrollment applications and deposits are due: NOW.

Your Name:
Your Name as It Should Appear on Your Certificate:
Your Date of Birth:

Your Mailing Address:
Street:
Apt. or Suite:
City:
State/Province:
Postal Code:
Country:

Your Email Address:
Your Telephone Number:

Please list any relevant professional qualifications that you have:

COLLECTIVE INTELLIGENCE ENROLLMENT OPTIONS

Residential Program: $3,100 US dollars. (Includes learning materials, tuition, private accommodations, meals.)
    Male Female
    Single Double (minus $15 per night)
    If Double with whom will you share a bedroom?

Tuition Only: $1,975 US dollars. (Includes learning materials and tuition.)

Deposit to be applied toward total fees: $2,000 US dollars or $1,975 for Tuition Only option. (Holds your place in the course.)

Grand Total for all Fees $
Deposit amount authorized $ Balance Due $

METHODS OF PAYMENT

Bank Check - NLPU prefers that you send a check in US dollars. At your bank you can ask for a check to be made out to NLP University and then send it to:
    NLP University, P.O. Box 1112, Ben Lomond, California 95005. USA
or

Bank Transfer - If you would like to make a bank transfer, please transfer in US dollars to the NLP University Checking Account:
    Bank of America, 555 California St., San Francisco, California 94104, USA
    Telephone: (800) 432-1000
This is all you need:
    Swift Code: BofAUS3N
    NLP University Checking Account: 325073177409
    Wire transfer routing # 026009593
or

Visa Mastercard (Sorry, no American Express)
    Card Number
    Expiration (Month/Year) 3 Digit Code on Back
    NOTE: For added security, you may send the credit card numbers in 2-3 separate emails.

    Deposit Authorized Now $
or

Some Cash US Dollars can be paid at Registration.

or

A Payment Plan, guaranteed with a Visa or Mastercard, can be arranged.

If you decide to cancel for any reason, all the money you have paid is 100% refundable, minus a $250.00 cancellation fee.

Please make checks payable to NLP University and submit your completed enrollment form to reserve your place.


CONFIDENTIAL PARTICIPANT INFORMATION

Please read carefully, answer and confirm accuracy.

Are you or have you recently been using any kind of medication? Yes No
If Yes, please explain:


Are you now or have you recently been under the care of a doctor, psychiatrist or psychologist? Yes No
If Yes, please explain:


Is there a history of mental illness in your family? Yes No
If Yes, please explain:


Do you have physical problems or disabilities for which you will need assistance? Yes No
If Yes, please explain:


If you are currently under the care of a doctor, psychiatrist or psychologist, please provide us with the appropriate contact information below, including telephone numbers:
1. Name: Telephone:
2. Name: Telephone:

The University of California, where NLPU is held, does not allow inappropriate use of drugs or alcohol on campus. Please indicate if you have had a dependency problem: Yes No

Emergency Contact Information: All participants, please provide the names and telephone numbers at work and home for two people that we can be in contact with in case of an emergency:
1. Name:
    Work: Home:
2. Name:
    Work: Home:

The participant clearly understands: the education being provided is solely for avocational / recreational purposes and is not intended to provide training for employment. Such education is being pursued for personal entertainment, recreation, individual edification or as a hobby.

Participants at NLP University are expected to behave respectfully and ethically toward fellow participants, NLP University and University of California staff. Participants who disrupt the educational flow of NLPU with inappropriate behavior will not be assessed for certification and may be asked to leave the campus.

No independent audio or video recording is allowed. Audio recordings will be available for all classes at different prices.

NLP University's right to deny entry into a program is reserved.

The University campus is a special learning environment. We feel privileged to offer these NLP programs at the UCSC campus, where NLP was founded. NLPU tries to maintain an environment conducive to learning and would appreciate your cooperation with these guidelines.

Please feel free to check with NLP University if you have questions. Thank you.

The answers I have provided are accurate and complete.
I confirm that I have read, clearly understand and agree to the above policies.
Date:

Click here to when done.

Thank you.

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