professional certification

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registration form

Copy and paste the form below into an email and then fill out and send.
(copy by clicking and dragging across the form from top to bottom.)

Registration for Professional Emotional Clearing Facilitator Certification Training Start Date: Name (fill in your name as you want it to appear on your certificate): Sex: Date of Birth: Phone: Work & Home: Address: Credit/Debit Card Info (must provide if you are paying in installments): Type of card (Visa or Mastercard only): Card Number: Card Expiration Date: Address: If you are a US citizen, the billing address for the card must be listed above including zip code. Current Profession:   How do you envision using your Certification?   Other Professional Credentials / Relevant Life Experience (not req'd for cert.):   Anything Else:

email to: jrusk@emclear.com
Put EC TRAINING in the email subject line

Then, send your Registration Deposit from the order page.