Basic Class Registration

Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Choose class date:*

Jun 7-8, 2025 - Saturday & Sunday - NeurOptimal Basic Certification CourseSep 27-28, 2025 - Saturday & Sunday - NeurOptimal Basic Certification CourseDec 15-16, 2025 - Saturday & Sunday - NeurOptimal Basic Certification Course

Are you a NeurOptimal system owner?*

YesNo

Please enter your name exactly as you would like it to be printed on your course completion certificate.*

Comments/Questions:

My Products*

Full Payment - NeurOptimal Basic Certification CoursePay in full to secure your spot today! Payment for courses is nonrefundable.

$660.00

Installment Plan - NeurOptimal Basic Certification CoursePay a deposit of 50% of the class cost to hold your spot in the class. The remaining 50% of the class cost is due 30 days prior to the class start date; you will receive an invoice via email for the balance. This deposit is nonrefundable.

$330.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration