"*" indicates required fields Are you new to the training or a repeating student?* I'm new to the training I am a repeating student as I have previously completed Divine Healing Level 1 A note regarding the Save and Continue Option*There is a Save and Continue option at the bottom of this form in case you need more time to fill it in. Please be aware that your place is NOT SECURE until you have completed the form AND made payment (deposit or in full). I am aware that my place is only confirmed when the completed form is submitted along with my payment (deposit or in full). Contact DetailsFirst Name*Last Name*Birth Certificate Name*Include all names on birth certificate Do You Have a Non-English Pronounced Name? Non-English Pronounced Name? For all non-english names (including your birth certificate name and currently used name) it is ESSENTIAL to send us a recording of your names pronounced as they would have been by parents at the time of naming. When recording, say the name at normal speed once, then three times more slowly at the same speed. If you don't speak the language then please ask someone that does to do the recording. Use the software Vocaroo (link below) or Speak Pipe to record the pronunciation of all non-english names. Then copy the link and add it below. Record Your Name Pronunciations Here using Vocaroo/ Record Your Name using Speak Pipe Share your Vocaroo/Speak Pipe link hereAlternatively upload your MP3 hereOccasionally Vocaroo/ Speak Pipe doesn't work for people. In this instance you can record your voice and save it as a MP3 and upload it below.Max. file size: 512 MB. Your name as you would like it to appear on your training certificate*Date of Birth (DAY/MONTH/YEAR*For example 30/October/1980 or 30/10/1980Mobile/Cell phone number (inc country code)*Landline phone number (inc country code):*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Time zone*Email address* Enter Email Confirm Email About youThe reason we ask these questions is for us to get an understanding of your history, so if anything comes up in the training we can handle it accordingly. All the information you submit is strictly private and confidential. Medical History*Have you had any operations, accidents, illnesses, medication (Including psychiatric history)? Yes No If yes please explainPresent health and medication.*Please describe your present health including any medication you are taking regularly.Mother’s Birth Certificate Name and Date of Birth*Relationship with mother*Describe your relationship with your Mother – whilst growing up & how it is now. Father's Birth Certificate Name and Date of Birth*Relationship with Father*Describe your relationship with your Father – whilst growing up & how it is now. Gestation and Birth*Please state how long you were in the womb for and what was the circumstances of your delivery (e.g. premature, method of delivery etc.) Drugs*Have you ever taken recreational drugs (if yes, list them all)?Have you ever abused alcohol?* Yes No If yes please explainHave you ever smoked?* Yes No If yes please give further detailsDental Work*Have you had any major dental work? Yes No Dental Work ExplainedIf yes, please explain what and when it was Do You Recall Any Emotional Traumas?* Yes No Emotional Trauma ExplainedPlease list all emotional trauma you recallDo You Have Any Allergies?* Yes No Allergies ExplainedPlease list all allergiesDo You Have Any Addictions/Cravings?* Yes No Addictions/Cravings ExplainedPlease list all addictionsYour Environment*Describe your present home and family environment. Your Occupation*Describe your main occupation. Are you happy in it?Diet*Describe your diet.Activity and Exercise*Describe your level of activity and exercise. Sexuality*Do you feel your sexuality is flowing or is blocked in any way. Now or in the past? The reason we ask about your sexuality is that it's often an important indicator into how deeply your emotional separation programming is impacting your life force. Menstrual Cycle*Describe your Menstrual Cycle (e.g. Regular, irregular, PMS). If this question does not apply please write N/A Practices*Do you meditate or have a spiritual practice? More About YouWhat brought you to this training?*Tell us a little about what you are hoping to achieve and what are your objectives with using this training in the future.EQ-Emotional Intelligence*How well can you feel the full range of human emotions e.g. fear, anger, despair, grief, anguish, terror, guilt, shame, hopelessness, rejection, abandonment, mistrust, unworthinessRelevant experience*Tell us more about your background in terms of healing, facilitation, teaching, training and/or experience in delivering these services.Terms and ConditionsPlease read carefully so you understand what you’re checking below as there are no refunds once you complete the purchase*1. I agree to attend all training sessions. 2. I agree to commit to the full training. 3. I agree that all readings and processes, everything shared by teachers and students is strictly private and confidential, and not to be shared outside of the training, in order to create a safe space for all concerned. 4. I agree that if I withdraw before the training commences and have not paid the balance of the course fees, only the deposit is non-refundable. If I withdraw after I have received access to the downloadable course manuals, the full course fees are non-refundable, but may be transferred to a future training within two years. 5. I agree that any package I purchase is non-refundable and once I’ve paid for a package and been given access to the course materials the balance cannot be transferred to another training. 6. If you’re thinking about doing more trainings in the future give some consideration to including all the trainings in a single package in order to get the best discount, as once you commit to a package you cannot incrementally add more trainings to it and benefit from the increased discounts offered. 7. Please be aware of the training calendar dates of the trainings you purchase. If you are not aware of the dates before purchasing a package please contact us to find out. I agree to all the above FAQ's*I have read the FAQ section here: https://centerforconsciousascension.net/dh_training/faqs/ and understand that the training is A LIVE TRAINING that I need to attend in person on the dates stated. Yes, I have read the FAQ's and understand that I need to ATTEND THE TRAINING IN PERSON on the dates stated. PaymentWhat would you like to pay right now?* Payment Options Flexible Payment Options May Be Available After submitting your form, you will be redirected to a secure payment page where you can enter the amount you wish to pay. Depending on your location and personal circumstances, you may be offered Buy Now, Pay Later options at checkout, such as Afterpay, Clearpay, Klarna and PayPal Pay in 3. If available to you, these options allow you to spread the cost over three or four instalments, making it easier to manage the cost of your training or package. Please note: Payment plan availability is determined by the provider at checkout and cannot be guaranteed. I would like to pay the course fee in full totalling £571 I would like to secure my place by paying the non-refundable deposit of £193 and commit to paying the remainder in full before the training commences I would like to pay for the Divine Healing Package (DH1 + DH2) of £1051 (8% discount saving £91) I would like to pay for the Divine Healing and Soul Contract Package (DH1 + SC1) for £1186 (8% discount saving £103) I would like to pay for the Divine Healing Level 1 + Soul Contract Level 1 + Phonetics Support & Development Training Package for £1600 (10% discount saving £179) I would like to pay the repeating student fee of £193 Marketing and ReferralsWhere did you hear about this training?* I was referred by someone Soul Contract Reader software Center for Conscious Ascension website Center for Conscious Ascension newsletter Center for Conscious Ascension social media (facebook or twitter) What is the full name of the FIRST person who referred you and the DATE they did so?Would you like to join the Center for Conscious Ascension Mailing List?* Yes No Please note that your place is only confirmed once you have submitted the form AND completed payment.