Application - Transpersonal Development Date First Name*Last Name*Address*City*State*Zip*Home PhoneMobile PhoneEmail* How did you learn about this program?Professional degreeDo you have a current license or certification?YesNoStateCurrent place of employmentPlease give us a brief description of the types of people you work with?What has interested you in attending this program?What are you hoping for in attending?Please tell us what your experience has been with imagery and meditation. What is your personal interest and your professional interest?Please submit this application with your $100 non-refundable application fee.Pay with PayPalSend a checkPay with PayPal Price: $100.00 Send check made out to HMIC and mail to: 2 Murray Court Huntington, NY 11743Tuition for the course is $795, and must be paid 30 days before the course begins. Would you like to pay now or send a check?*Pay now with PayPalSend a checkPay now with PayPal Price: $795.00 Send check made out to HMIC and mail to: 2 Murray Court Huntington, NY 11743Send check made out to HMIC and mail to: 2 Murray Court Huntington, NY 11743Total $0.00 PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.