NLP SELF MASTERY LEVEL II REGISTRATION FORMS

Name Seminar Date Enrollment Coordinator

Congratulations! Your decision to participate in the NLP Self Mastery Level II is a significant and inspiring step toward creating the life you want now. Please complete pages 1-3 and send to WINGS Seminars as soon as possible. •E-mail: registration@wings-seminars.com•Fax: 541.683.6904•Mail: 275 W 5th Ave, Eugene, OR 97401

Your tuition balance is due 14 days prior to the seminar date.

Name you prefer on your name tag Birth date Mailing Address City State Zip Home phone Cell phone E-Mail Name of your business/employer Work phone Job Title Are you in a committed relationship? ❍Y or ❍N Partners Name Emergency contact name Phone Relation to you

In case of emergency we will use the nearest hospital unless otherwise noted.

COMMITMENT POLICY By registering for this seminar, you’re making a commitment not only to yourself and your quality of life, but also to Wings. The following commitments are in place to support you in creating what you want and to assist Wings to achieve the best possible seminar experience for each participant.

After reading each statement below, check the box to the left indicating that you have read and agree to each statement.

Your non-refundable deposit reserves your place. Your tuition balance is due no later than 14 days prior to the seminar start date and once paid is nonrefundable.

Cancellations/transfers must be made by phone with your Enrollment Coordinator at 800.697.0040. Our office hours are M-F 8:30am - 5:00pm PST.

Your registration applies to a specific seminar and date. If you cannot attend the seminar for which you registered, the dollar amount of the paid tuition can be credited towards a WINGS seminar within the

following guidelines: o Your credit must be used within eight months from your original seminar date. o A $50 fee will apply to each transfer. This fee will be charged to the credit card used at the time of

registration. The transfer fee will be waived if the transfer is to an earlier date. o Early advancement discounts will not apply when transferring to a seminar outside the agreed time

frame. The difference in tuition must be paid 14 days prior to the new seminar start date. o You may transfer your credit to another person following the above guidelines.

In the event that you must cancel, all payments can be credited towards a future WINGS seminar within 8 months from your original seminar start date.

24-hour Cancellations/Transfers: Cancellations/Transfers that occur within 24 hours of the start of any WINGS seminar will incur a $100 late notice fee. This fee will be charged to the credit card used at the time of registration.

I have read and agree to the Commitment Policy as stated above.

NLP SELF MASTERY LEVEL II QUESTIONNAIRE Our intention is to create the best possible learning environment for all participants, one that is both stimulating and supportive.

Your responses are held strictly confidential within Wings Seminars.

1. Do you have any special concerns or considerations that you want us to know about?

❍Yes ❍No If yes, what?

2. What is compelling to you about learning and practicing NLP?

I have answered the above questions fully and honestly. I understand that it is my responsibility to participate in a manner that is physically and emotionally safe for me.

GENERAL RELEASE I understand that my participation in this seminar, or in any part of a Wings seminar and/or associated services and activities, is wholly voluntary. The seminars offered by Wings Seminars/Innovative Learning Group are for educational purposes only and are not a form of treatment or therapy for any emotional, mental, or physical problems of the undersigned. In consideration of my being permitted to participate in this seminar, I hereby release, hold harmless and indemnify Wings Seminars, it's successors and assigns, staff, personnel, and assist team members from all claims made by me, or on behalf of myself or my estate, for any illness or damage arising from my participation in such seminar or related services and activities. I assume full responsibility for any and all effects of my taking part in these programs.

I understand and agree to the General Release as stated above.

MUTUAL CONFIDENTIALITY AGREEMENT I further understand that participation in a Wings seminar is a private experience for each participant. As a consequence, I agree to hold confidential all remarks and behaviors of all participants; to treat as personal and private all their comments, experiences, and interactions in the seminar.

I understand and agree to the Mutual Confidentiality Agreement as stated above.

CONTINUING EDUCATION Wings Seminars is accredited by the International Association of Continuing Education and Training (IACET) to provide Continuing Education Units to participants of NLP Self Mastery Level II. Please contact Wings Seminars in advance of your seminar to receive Continuing Education Credits. For more information visit Continuing Education section of our website for the steps necessary to receive credit for participating in the NLP Self Mastery Level II.

I acknowledge that I have read and understood the terms and conditions and answered all questions completely and accurately. By entering my name below, I sign this form with a

binding electronic signature.

Name Date